Shoreline Psychological Services, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY9365 Issued in FL

Legal business name

SHORELINE PSYCHOLOGICAL SERVICES, LLC

Practice address

146 2ND St N
Suite 310
St Petersburg, FL 33701-3328

Phone

(727) 251-6874

NPI assigned

Nov 9, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Theodora Coffman, PH.D.NPI 1922475599

Title

Psychologist

Phone

(727) 308-1180

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theodora P Coffman, PH.D

  • Psychologist
  • St Petersburg, FL
  • NPI 1922475599

  NC

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1478649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686873600000",
    "number": "1093257982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 2ND ST N",
            "address_2": "SUITE 310",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013328",
            "telephone_number": "727-251-6874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 2ND ST N",
            "address_2": "SUITE 310",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013328",
            "telephone_number": "727-251-6874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-09",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A",
        "authorized_official_last_name": "COFFMAN",
        "authorized_official_first_name": "THEODORA",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "727-308-1180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY9365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan David Shoopak, D.M.D.,P.A.
• Anna Shoopak, D.M.D.
• Shore Acres Nursing and Rehab LLC
• Shore Facility Inc (Shore Acres Care Center)
• Shoreline Counselor
• Margaret Short
• Melanie Elenora Short, DC
• Richard Lester Short III, D.O.
• Adriana Shorter
• Cedric D. Shorter, M.D.

• Psychologist in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.