Active NPI
Shana Nichols, PHD
- Psychologist
- Melville, NY
National Provider Identifier
1073605614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 016634
- Practice address
- 63 Old East Neck Rd
Melville, NY 11747-2806 - Phone
- (631) 923-0923
- NPI assigned
- Sep 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 016634 | NY | Primary |
| Clinical Psychologist | 103TC0700X | 2951 | CO | |
| Clinical Psychologist | 103TC0700X | 2011000658 | MO | |
| Clinical Psychologist | 103TC0700X | 001285 | IA |
Addresses
Primary practice location
63 Old East Neck Rd
Melville, NY 11747-2806
Mailing address
63 Old East Neck Rd
Melville, NY 11747-2806
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011000658 | MO | MD | Clinical Psychologist |
| 016634 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429488000000",
"number": "1073605614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 OLD EAST NECK RD",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117472806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 OLD EAST NECK RD",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117472806",
"telephone_number": "631-923-0923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "SHANA",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2015-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "016634",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "2951",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "2011000658",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "001285",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.