Active NPI
Shelley Marie Mydra, M.A., LMFT
- Marriage & Family Therapist
- Minnetonka, MN
National Provider Identifier
1104136134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 1861
- Practice address
- 5523 Wingwood CT
Minnetonka, MN 55345-5660 - Phone
- (952) 484-1888
- NPI assigned
- Oct 8, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1861 | MN | Primary |
Addresses
Primary practice location
5523 Wingwood CT
Minnetonka, MN 55345-5660
Mailing address
5523 Wingwood CT
Minnetonka, MN 55345-5660
Phone (952) 484-1888
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1861 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286496000000",
"number": "1104136134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5523 WINGWOOD CT",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553455660",
"telephone_number": "952-484-1888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5523 WINGWOOD CT",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553455660",
"telephone_number": "952-484-1888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYDRA",
"first_name": "SHELLEY",
"middle_name": "MARIE",
"credential": "M.A., LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-08",
"last_updated": "2010-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "1861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.