Shana Mari Cacioppo, PSY. D, LLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301013864 Issued in MI

Practice address

25507 Ecorse Rd
Taylor, MI 48180-1555

Phone

(313) 292-7640

Fax

(313) 292-9270

NPI assigned

Jun 10, 2008

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330387200000",
    "number": "1619137007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 19TH ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481926029",
            "telephone_number": "734-320-9562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25507 ECORSE RD",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481801555",
            "telephone_number": "313-292-7640",
            "fax_number": "313-292-9270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACIOPPO",
        "first_name": "SHANA",
        "middle_name": "MARI",
        "name_prefix": "Mrs.",
        "credential": "PSY. D, LLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-10",
        "last_updated": "2012-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301013864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Taylor, MI
• Providers in Taylor, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; 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.