Active NPI
Shari Faye Fanelli, MS, LPC, ATR
- Professional Counselor
- Stamford, CT
National Provider Identifier
1689948887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 002004
- Practice address
- 103 W Broad St
Stamford, CT 06902-3713 - Phone
- (203) 517-3368
- NPI assigned
- Mar 6, 2012
- Last updated
- Mar 6, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 002004 | CT | Primary |
Addresses
Primary practice location
103 W Broad St
Stamford, CT 06902-3713
Mailing address
144 Sylvan Knoll Rd
Stamford, CT 06902-5355
Phone (201) 446-8677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004 | CT | MD | Physical Therapy Assistant |
| 002004 | CT | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Center Inc | Current | Accepting new patients | |
| Community Health Center Inc | Current | Accepting new patients | |
| Beehive Counseling & Wellness LLC | Past | Accepting new patients |
Locations
19 Grand St
Middletown, CT 06457
Phone (860) 323-0172
Interoperability endpoints
- shari.fanelli@chcict.eclinicaldirectplus.com
Organizations & group practices 3
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.
-
- Federally Qualified Health Center (FQHC)
- Middletown, CT
- NPI 1952591851
-
dba City of Danbury Emergency Shelter WYA
- Federally Qualified Health Center (FQHC)
- Danbury, CT
- NPI 1003332446
-
- Marriage & Family Therapist
- Manchester, CT
- NPI 1003477829
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330992000000",
"number": "1689948887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "144 SYLVAN KNOLL RD",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069025355",
"telephone_number": "201-446-8677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 W BROAD ST",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069023713",
"telephone_number": "203-517-3368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANELLI",
"first_name": "SHARI",
"middle_name": "FAYE",
"credential": "MS, LPC, ATR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-03-06",
"last_updated": "2012-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CT",
"license": "002004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stamford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.