Individual provider Active NPI

Sharon Marie Nelson, PHD

  • Clinical Psychologist
  • Ypsilanti, MI
National Provider Identifier
1679145601
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301018908 Issued in MI
Practice address
993 E Cross St
Ypsilanti, MI 48198-3815
Phone
(717) 802-1597
NPI assigned
Jul 9, 2021
Last updated
Jul 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301018908 MI Primary

Addresses

Primary practice location

993 E Cross St
Ypsilanti, MI 48198-3815

Mailing address

993 E Cross St
Ypsilanti, MI 48198-3815

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20240620000223 PA Practitioner - Clinical Psychologist 8820531700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301018908MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Pennsylvania State University CurrentSince Apr 30, 2024 Accepting new patients
The Pennsylvania State University CurrentSince Apr 30, 2024 Accepting new patients

Organizations & group practices 2

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": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1679145601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "993 E CROSS ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481983815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "993 E CROSS ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481983815",
            "telephone_number": "717-802-1597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "SHARON",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301018908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.