Individual provider Active NPI

Shelley Roye Nystrom, MA

  • Marriage & Family Therapist
  • Saint Paul, MN
National Provider Identifier
1669355814
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
4680 Issued in MN
Practice address
1919 University Ave W Ste 425
Saint Paul, MN 55104-3598
Phone
(651) 212-5288
Fax
(612) 677-3736
NPI assigned
Jul 28, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 4680 MN Primary

Addresses

Primary practice location

1919 University Ave W Ste 425
Saint Paul, MN 55104-3598

Mailing address

1919 University Ave W Ste 425
Saint Paul, MN 55104-3598
Phone (651) 212-5288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20250819002300 MN Practitioner - Marriage and Family Therapist 0042719783 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1919 University Ave W
Saint Paul, MN 55104-3598

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
4680MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
The Institute for Relational Well-Being Marriage & Family Therapist CurrentSince Jul 28, 2025 Accepting new patients

Locations

1919 University Ave W
Ste 425
Saint Paul, MN 55104
Phone (651) 212-5288

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1753660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1669355814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 UNIVERSITY AVE W STE 425",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043598",
            "telephone_number": "651-212-5288",
            "fax_number": "612-677-3736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 UNIVERSITY AVE W STE 425",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043598",
            "telephone_number": "651-212-5288",
            "fax_number": "612-677-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYSTROM",
        "first_name": "SHELLEY",
        "middle_name": "ROYE",
        "name_prefix": "Mrs.",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-28",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "4680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.