Edward George Shelleby, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2897 Issued in OH

Practice address

115 Elm Ave
Wyoming, OH 45215-4325

Phone

(513) 559-2066

Fax

(513) 559-2009

NPI assigned

Dec 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124186267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 ELM AVE",
            "city": "WYOMING",
            "state": "OH",
            "postal_code": "452154325",
            "telephone_number": "513-559-2066",
            "fax_number": "513-559-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ELM AVE",
            "city": "WYOMING",
            "state": "OH",
            "postal_code": "452154325",
            "telephone_number": "513-559-2066",
            "fax_number": "513-559-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLEBY",
        "first_name": "EDWARD",
        "middle_name": "GEORGE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "2897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0410380",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Resnik, MSW, LSW
• Spencer R Rickert, DPT
• Ramona L. Rousseau-Robinson
• Blakney Scott
• Seniority Wellness & Consulting LLC
• Latoya N Smith, STNA, CCMA
• Karen Marie Tanveer, M.A.
• Rene Thomas, PT
• Wyoming Youth Services Bureau

• All providers in Wyoming, OH
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.