Shiva Rezvan Homami, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

003650 Issued in CT

Practice address

1095 S Main St
Cheshire, CT 06410-3432

Phone

(203) 271-3809

NPI assigned

Nov 19, 2017

Last updated

Jun 26, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in CT

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

State licenses

Practice roles

Locations

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

• Comprehensive Neuropsychological Services, P.C.

  • Clinical Psychologist
  • Cheshire, CT
  • NPI 1780790352
  Medicare reassignment NPD

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

{
    "created_epoch": "1511049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1265946842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 S MAIN ST",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064103432",
            "telephone_number": "570-472-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 S MAIN ST",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064103432",
            "telephone_number": "203-271-3809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZVAN HOMAMI",
        "first_name": "SHIVA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-19",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "003650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renewed Health and Wellness LLC
• Restoring You Wellness Center LLC
• Anna Reutenauer, DDS
• John Joseph Revere Jr., RPH
• Elizabeth Marilyn Reynolds
• Caylee Ribeiro
• Jordan Richard, SPEECH THERAPIST
• Erin Richards, OT
• Katherine Richardson
• Raenette G Riddick

• Clinical Psychologist in Cheshire, CT
• Providers in Cheshire, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; 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.