Active NPI
Shane Shackford, PSY.D
- School Psychologist
- Galloway, NJ
National Provider Identifier
1134405533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 2516
- Practice address
- 325 E Jimmie Leeds Rd
Suite 182
Galloway, NJ 08205-4126 - Phone
- (609) 325-8775
- NPI assigned
- Oct 29, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 2516 | NJ | Primary |
Addresses
Primary practice location
325 E Jimmie Leeds Rd
Suite 182
Galloway, NJ 08205-4126
Mailing address
325 E Jimmie Leeds Rd
Suite 182
Galloway, NJ 08205-4126
Phone (609) 325-8775
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2516 | NJ | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319846400000",
"number": "1134405533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 E JIMMIE LEEDS RD",
"address_2": "SUITE 182",
"city": "GALLOWAY",
"state": "NJ",
"postal_code": "082054126",
"telephone_number": "609-325-8775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 E JIMMIE LEEDS RD",
"address_2": "SUITE 182",
"city": "GALLOWAY",
"state": "NJ",
"postal_code": "082054126",
"telephone_number": "609-325-8775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKFORD",
"first_name": "SHANE",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-29",
"last_updated": "2011-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NJ",
"license": "2516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Galloway, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.