Shirley Ann Davis-Susser, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

010347-1 Issued in NY

Practice address

48 Loockerman Ave
Poughkeepsie, NY 12601-5011

Phone

(845) 471-8645

Fax

(845) 471-7820

NPI assigned

Mar 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shirl Ross Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 31, 2022 through Dec 31, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Steven J Cornell,DPM

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  • NPI 1154693430
  NPD (past)
• Steven J. Cornell, DPM

  • Durable Medical Equipment & Medical Supplies
  • Poughkeepsie, NY
  • NPI 1669654273
  NPD (past)

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1134189459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 LOOCKERMAN AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126015011",
            "telephone_number": "845-471-8645",
            "fax_number": "845-471-7820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 LOOCKERMAN AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126015011",
            "telephone_number": "845-471-8645",
            "fax_number": "845-471-7820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS-SUSSER",
        "first_name": "SHIRLEY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-23",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "010347",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "010347-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI PIN#",
            "identifier": "6800096",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHIRL",
            "last_name": "ROSS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lev Davidson, M.D.
• Vera Davidson, M.S., CCC-SLP
• Allison Davie, LPN
• Catherine E Davies, LMSW
• Michael Davino, RN
• Allison Davis, LPN
• Freda L Davis, LPN
• Hyacinth Evadne Davis, LPN
• Lauren Davis, PA-C
• Lauren A Davis, PHARMD

• Clinical Psychologist in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; 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.