Shannon Kelly, PSY.D.

Primary specialty

Health Service PsychologistTaxonomy code 103TH0100X

License

PY7017 Issued in FL

Practice address

6001 Brick CT
Suite 201
Winter Park, FL 32792-9425

Phone

(407) 671-1123

Fax

(407) 671-1233

NPI assigned

Apr 5, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrative Health Psychology PA

  • Clinical Psychologist
  • Oviedo, FL
  • NPI 1457353930
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457313330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6001 BRICK CT",
            "address_2": "SUITE 201",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327929425",
            "telephone_number": "407-671-1123",
            "fax_number": "407-671-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6001 BRICK CT",
            "address_2": "SUITE 201",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327929425",
            "telephone_number": "407-671-1123",
            "fax_number": "407-671-1233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "FL",
            "license": "PY7017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaman Michelle Keller, APRN
• Kelley Eye, LLC
• Kaitlyn Kelley, OD
• Victoire Elite Kelley, MD
• Priscilla Jean Kelly, LMHC
• Jennifer M Kelsey, ARNP
• Kemeh Medical LLC
• Kamy Rae Kemp, MD
• Kelly Kemp, M. ED., LMHC
• Jacqueline Kendona

• Health Service Psychologist in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Health Service Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.