Shirley Boone-Sanford, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

002451 Issued in GA

Practice address

485 S Perry St
Suite D
Lawrenceville, GA 30045-4923

Phone

(678) 205-0838

Fax

(678) 205-0800

NPI assigned

Mar 29, 2006

Last updated

Jan 3, 2008By the provider in NPPES

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

Enrolled in GA

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

Southern Illinois University School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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

• SBS Psychological Associates

  • Psychologist
  • Lawrenceville, GA
  • NPI 1437323029
  Medicare reassignment NPD Authorized official
• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment Care Compare group NPD
• DRM Consulting Services, Inc

  • Clinical Psychologist
  • Lawrenceville, GA
  • NPI 1639343221
  NPD (past)

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199318400000",
    "number": "1609837616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2133",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300462133",
            "telephone_number": "678-205-0838",
            "fax_number": "678-205-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 S PERRY ST",
            "address_2": "SUITE D",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300454923",
            "telephone_number": "678-205-0838",
            "fax_number": "678-205-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOONE-SANFORD",
        "first_name": "SHIRLEY",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-29",
        "last_updated": "2008-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "002451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Carolina Bono
• Mary Alice McBurney Bonselaar, PT, DPT
• Megan E Bonselaar, OTR/L
• Rebecca Anne Booker, PMHNP
• Shalanda Monique Booker
• Boostcare LLC
• Jacqueline Boreland, RN
• Ashley Attaway Born
• Angela Bostic-Maddox
• Scott G Boswell

• Psychologist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; 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.