Active NPI
Shannon Maureen Nicoloff, PSY.D., L.P., RPT
- Psychologist
- Johnstown, PA
National Provider Identifier
1285892372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS017512
- Practice address
- 323 Budfield St
Johnstown, PA 15904-3213 - Phone
- (651) 894-2916
- NPI assigned
- May 27, 2008
- Last updated
- Jun 18, 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 | PS017512 | PA | Primary |
Addresses
Primary practice location
323 Budfield St
Johnstown, PA 15904-3213
Mailing address
807 Sunnehanna Drive
Johnstown, PA 15905
Phone (651) 894-2916
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403049600000",
"number": "1285892372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "807 SUNNEHANNA DRIVE",
"city": "JOHNSTOWN",
"state": "PA",
"postal_code": "15905",
"telephone_number": "651-894-2916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "323 BUDFIELD ST",
"city": "JOHNSTOWN",
"state": "PA",
"postal_code": "159043213",
"telephone_number": "651-894-2916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLOFF",
"first_name": "SHANNON",
"middle_name": "MAUREEN",
"name_prefix": "Dr.",
"credential": "PSY.D., L.P., RPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-27",
"last_updated": "2014-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS017512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnstown, PA
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- New Dimensions Dentistry and Orthodontics, P.C.
- Nicholas J. Masciotra MD PC
- Kelly Lynn Nicodemus
- Katelyn Ann Niebauer, CRNP
- Heidi A Niessner
- NJ Peer Support Specialists LLC
- John B Nobiletti, M.D., PH.D.
- Zachary Ryan Nolan, CRNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.