Active NPI
Shelton Keith Gilyard Jr.
- Intellectual & Developmental Disabilities Psychologist
- Valrico, FL
National Provider Identifier
1437319712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual & Developmental Disabilities Psychologist
- License
- 222Q00000X
- Practice address
- 4606 Tucson CT
Valrico, FL 33594-9315 - Phone
- (813) 684-8906
- Fax
- (813) 974-6115
- NPI assigned
- Jun 11, 2008
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 222Q00000X | FL | Primary |
Addresses
Primary practice location
4606 Tucson CT
Valrico, FL 33594-9315
Mailing address
4606 Tucson CT
Valrico, FL 33594-9315
Phone (813) 684-8906
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 |
|---|---|---|---|
| 222Q00000X | FL | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213142400000",
"number": "1437319712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4606 TUCSON CT",
"city": "VALRICO",
"state": "FL",
"postal_code": "335949315",
"telephone_number": "813-684-8906",
"fax_number": "813-974-6115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4606 TUCSON CT",
"city": "VALRICO",
"state": "FL",
"postal_code": "335949315",
"telephone_number": "813-684-8906",
"fax_number": "813-974-6115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILYARD",
"first_name": "SHELTON",
"middle_name": "KEITH",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-11",
"last_updated": "2008-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "FL",
"license": "222Q00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valrico, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.