Individual provider Active NPI

Melissa Shulman, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fairfield, CT
National Provider Identifier
1639877889
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
0998458 Issued in CO
Practice address
1506 Post Rd Ste 2
Fairfield, CT 06824-5916
Phone
(720) 770-8222
NPI assigned
Feb 17, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0998458 CO Primary

Addresses

Primary practice location

1506 Post Rd Ste 2
Fairfield, CT 06824-5916

Mailing address

1506 Post Rd Ste 2
Fairfield, CT 06824-5916
Phone (720) 770-8222

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: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0998458COMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The 40 20 Collective LLC Psychiatric/Mental Health CurrentSince Mar 7, 2023 Accepting new patients

Locations

14143 Denver West Pkwy
Ste 100
Lakewood, CO 80401
Phone (720) 594-5556

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26636/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1639877889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 POST RD STE 2",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245916",
            "telephone_number": "720-770-8222",
            "fax_number": "844-218-1132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 POST RD STE 2",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245916",
            "telephone_number": "720-770-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULMAN",
        "first_name": "MELISSA",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-17",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "0998458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

Verify at the official NPI Registry.