Lynda Shane Blasko, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

004067 Issued in GA

Practice address

1409 North Highland Avenue
Suite J
Atlanta, GA 30306

Phone

(404) 908-1773

NPI assigned

Mar 8, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 23, 2023 through Jan 23, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1268006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1083937874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 OAKLAWN AVENUE NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "30319",
            "telephone_number": "404-908-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 NORTH HIGHLAND AVENUE",
            "address_2": "SUITE J",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30306",
            "telephone_number": "404-908-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLASKO",
        "first_name": "LYNDA",
        "middle_name": "SHANE",
        "name_prefix": "Mrs.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "GA",
            "license": "004067",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "004067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Richardson Blanton, DPT
• Sophie Blasberg
• Walter R Blase, M.S., A.T.C
• Alayna M Blash, DPM
• John Thomas Blasingame III, M.D.
• Mitchell A Blass, M.D.
• Tyler Blatchford
• Allison Brooke Blatt, PT
• Suzanne Marie Blauser, MD
• Rachel Ellen Blavos, PT, DPT

• Psychologist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.