Active NPI
Melissa Shanahan, PSYD
- Psychologist
- Atlanta, GA
National Provider Identifier
1639487309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY003402
- Practice address
- 1000 Johnson Ferry Road
Northside Hospital
Atlanta, GA 30342 - Phone
- (404) 365-0966
- NPI assigned
- Sep 16, 2010
- 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 | PSY003402 | GA | Primary |
Addresses
Primary practice location
1000 Johnson Ferry Road
Northside Hospital
Atlanta, GA 30342
Mailing address
3495 Piedmont Road, NE
Nine Piedmont Center
Atlanta, GA 30505
Phone (404) 364-7070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2020 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY003402 | GA | MD | Psychologist |
| 003402 | GA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427328000000",
"number": "1639487309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3495 PIEDMONT ROAD, NE",
"address_2": "NINE PIEDMONT CENTER",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30505",
"telephone_number": "404-364-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 JOHNSON FERRY ROAD",
"address_2": "NORTHSIDE HOSPITAL",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30342",
"telephone_number": "404-365-0966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANAHAN",
"first_name": "MELISSA",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-16",
"last_updated": "2015-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "GA",
"license": "PSY003402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.