Active NPI
Shannon Michele Daleiden,, PHD
- Clinical Psychologist
- Satellite Beach, FL
National Provider Identifier
1629264338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY7584
- Practice address
- 665 Grant CT
Satellite Beach, FL 32937-3945 - Phone
- (808) 781-4750
- Fax
- (321) 426-9054
- NPI assigned
- Sep 18, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Psychologist | 103TH0100X | 885 | OK | |
| Clinical Psychologist | 103TC0700X | PY7584 | FL | Primary |
Addresses
Primary practice location
665 Grant CT
Satellite Beach, FL 32937-3945
Mailing address
665 Grant CT
Satellite Beach, FL 32937-3945
Phone (808) 781-4750
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY7584 | FL | MD | Clinical Psychologist |
| 885 | OK | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439856000000",
"number": "1629264338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "665 GRANT CT",
"city": "SATELLITE BEACH",
"state": "FL",
"postal_code": "329373945",
"telephone_number": "808-781-4750",
"fax_number": "321-426-9054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "665 GRANT CT",
"city": "SATELLITE BEACH",
"state": "FL",
"postal_code": "329373945",
"telephone_number": "808-781-4750",
"fax_number": "321-426-9054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALEIDEN,",
"first_name": "SHANNON",
"middle_name": "MICHELE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-18",
"last_updated": "2015-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "OK",
"license": "885",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY7584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Satellite Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.