Active NPI
Kendahl Shortway, PSY.D.
- Psychologist
- Sparta, NJ
National Provider Identifier
1548832314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6459
- Practice address
- 25 Main St
Sparta, NJ 07871-1937 - Phone
- (908) 246-0553
- NPI assigned
- Jul 12, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6459 | NJ | Primary |
Addresses
Primary practice location
25 Main St
Sparta, NJ 07871-1937
Mailing address
136 Glen Rd Ext
Highland Lakes, NJ 07422-1919
Phone (201) 463-4911
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 |
|---|---|---|---|
| 6459 | NJ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1548832314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 GLEN RD EXT",
"city": "HIGHLAND LAKES",
"state": "NJ",
"postal_code": "074221919",
"telephone_number": "201-463-4911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 MAIN ST",
"city": "SPARTA",
"state": "NJ",
"postal_code": "078711937",
"telephone_number": "908-246-0553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORTWAY",
"first_name": "KENDAHL",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-12",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NJ",
"license": "6459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sparta, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.