John Floyd Shackelford I, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

22077 Issued in TX

Practice address

1701 Gateway Blvd Ste 405
Richardson, TX 75080-3627

Phone

(972) 979-1949

Fax

(972) 644-5512

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Deborah Reed, M.a.

  • Professional Counselor
  • Richardson, TX
  • NPI 1295196400
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467599340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 GATEWAY BLVD STE 405",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803627",
            "telephone_number": "972-979-1949",
            "fax_number": "972-644-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 GATEWAY BLVD STE 405",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750803627",
            "telephone_number": "972-979-1949",
            "fax_number": "972-644-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "JOHN",
        "middle_name": "FLOYD",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "22077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Serna, OTR
• Serviam Home Healthcare LLC.
• Kendra Laine Severs, M.A., CCC-SLP
• Sherry Arman Shaaf, PT
• Martez Shabazz
• Stacey Shaffer, CCC-SLP
• Florence Battle Shafiq, MD
• Virali Shah, M.S. CCC-SLP
• Shahida Rafiq, MD
• Massoud Shahidi

• Clinical Psychologist in Richardson, TX
• Providers in Richardson, TX by specialty
• Clinical Psychologist in Texas

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.