Active NPI
Shellie Renae Higuera
- School Psychologist
- Fairfield, CA
National Provider Identifier
1366051070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 3520
- Practice address
- 5059 Day Dr
Fairfield, CA 94533-6597 - Phone
- (916) 261-2743
- Fax
- (707) 437-3239
- NPI assigned
- Jul 28, 2020
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 3520 | CA | |
| Counseling Psychologist | 103TC1900X | 3520 | CA | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 3520 | CA | |
| Group Psychotherapy Psychologist | 103TP2701X | 3520 | CA | |
| School Psychologist | 103TS0200X | 3520 | CA | Primary |
Addresses
Primary practice location
5059 Day Dr
Fairfield, CA 94533-6597
Mailing address
5059 Day Dr
Fairfield, CA 94533-6597
Phone (916) 261-2743
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3520 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595894400000",
"number": "1366051070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5059 DAY DR",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336597",
"telephone_number": "916-261-2743",
"fax_number": "707-437-3239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5059 DAY DR",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336597",
"telephone_number": "916-261-2743",
"fax_number": "707-437-3239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HIGUERA",
"first_name": "SHELLIE",
"middle_name": "RENAE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-28",
"last_updated": "2020-07-28",
"certification_date": "2020-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "CA",
"license": "3520",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "CA",
"license": "3520",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "CA",
"license": "3520",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "CA",
"license": "3520",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "CA",
"license": "3520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.