Shannon Shortt, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810008143 Issued in VA

Practice address

6534 Pendleton Ave
Roanoke, VA 24019-4120

Phone

(540) 645-8933

NPI assigned

Oct 6, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shannon Malloy Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1245780840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 BOYLSTON ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6534 PENDLETON AVE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240194120",
            "telephone_number": "540-645-8933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORTT",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-06",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810008143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "MALLOY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Short, COTA/L
• Cecil C. Short, PA-C
• Ryan Maurer Short, PA-C
• Vera J. Short
• Robert J Shorter, LCSW
• Fatimat O Shotande, MD
• Brett Hampton Showalter, APRN, FNP-C
• Jessica Shrader, PTA
• Marikje Oosting Shreeve, CNS; PMHNP
• Pragya Shrestha, M.D.

• Clinical Psychologist in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.