Shaune Kelly Bornholdt, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

014867 Issued in NY

Practice address

1165 Morris Park Ave
Bronx, NY 10461-1915

Phone

(718) 430-3900

NPI assigned

Jun 20, 2008

Last updated

Jun 20, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Katherine S Bornholdt Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213920000000",
    "number": "1063673226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W 121ST ST",
            "address_2": "APT 52",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100275903",
            "telephone_number": "212-662-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 MORRIS PARK AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104611915",
            "telephone_number": "718-430-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORNHOLDT",
        "first_name": "SHAUNE",
        "middle_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-20",
        "last_updated": "2008-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "014867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "BORNHOLDT",
            "middle_name": "S",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michelle Borgese
• Kristin Borhofen
• Alla Borik, MD
• Michael Evan Boritz
• Rachel Borlack
• Berline Borno, LMSW
• Boro Medical, P.C.
• Alexis D Boro, MD
• Oresta Victoria Borodevyc, PA-C
• Veronika Borodina, R.N.

• Psychologist in Bronx, NY
• Providers in Bronx, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.