Active NPI
Jessie Anne Shah, PHD
- Psychologist
- Wellesley, MA
National Provider Identifier
1295027415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 9825
- Practice address
- 8 Grove St Ste 300
Wellesley, MA 02482-7739 - Phone
- (857) 626-6995
- NPI assigned
- May 5, 2011
- 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 | 9825 | MA | Primary |
Addresses
Primary practice location
8 Grove St Ste 300
Wellesley, MA 02482-7739
Mailing address
8 Grove St Ste 300
Wellesley, MA 02482-7739
Phone (857) 626-6995
Other names 1
- Dr. Jessie Anne Fontanella
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 13, 2021 through Sep 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9825 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549929600000",
"number": "1295027415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 GROVE ST STE 300",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024827739",
"telephone_number": "857-626-6995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 GROVE ST STE 300",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024827739",
"telephone_number": "857-626-6995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "JESSIE",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-05",
"last_updated": "2019-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "9825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JESSIE",
"last_name": "FONTANELLA",
"middle_name": "ANNE",
"prefix": "DR.",
"credential": "PHD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Wellesley, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.