Active NPI
Ellen Shustorovich, PH.D.
- Psychologist
- Rochester, NY
National Provider Identifier
1134546633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 020508
- Practice address
- 1513 South Ave
Rochester, NY 14620-2926 - Phone
- (585) 612-1016
- NPI assigned
- Mar 21, 2014
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 020508 | NY | Primary |
Addresses
Primary practice location
1513 South Ave
Rochester, NY 14620-2926
Mailing address
1513 South Ave
Rochester, NY 14620-2926
Phone (585) 612-1016
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020508 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407369600000",
"number": "1134546633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1513 SOUTH AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146202926",
"telephone_number": "585-612-1016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1513 SOUTH AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146202926",
"telephone_number": "585-612-1016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUSTOROVICH",
"first_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-21",
"last_updated": "2014-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "020508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.