Active NPI
Kassandra A. R. Shellabarger, PHD
- Clinical Psychologist
- Indianapolis, IN
National Provider Identifier
1396562070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20044050B
- Practice address
- 1002 Wishard Blvd
Indianapolis, IN 46202-2872 - Phone
- (317) 274-4779
- Fax
- (317) 948-9806
- NPI assigned
- Sep 24, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20044050B | IN | Primary |
| Clinical Neuropsychologist | 103G00000X | 20044050B | IN |
Addresses
Primary practice location
1002 Wishard Blvd
Indianapolis, IN 46202-2872
Mailing address
PO Box 719094
Chicago, IL 60677-9318
Phone (317) 777-6435
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300124477 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | PineRestCMHS@directaddress.pinerest.org | Direct |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20044050B | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776384000000",
"number": "1396562070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 719094",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606779318",
"telephone_number": "317-777-6435",
"fax_number": "317-777-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1002 WISHARD BLVD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462022872",
"telephone_number": "317-274-4779",
"fax_number": "317-948-9806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELLABARGER",
"first_name": "KASSANDRA",
"middle_name": "A. R.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-24",
"last_updated": "2026-04-17",
"certification_date": "2026-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20044050B",
"primary": true
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "IN",
"license": "20044050B",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300124477",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "PineRestCMHS@directaddress.pinerest.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "300 68th St SE",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495486927",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.