Active NPI
Elena Balashova-Shamis, PSYD
- Clinical Psychologist
- Marina del Rey, CA
National Provider Identifier
1740705367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY20104
- Practice address
- 4712 Admiralty Way Ste 591
Marina del Rey, CA 90292-6905 - Phone
- (310) 850-1699
- NPI assigned
- Aug 4, 2017
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY20104 | CA | Primary |
Addresses
Primary practice location
4712 Admiralty Way Ste 591
Marina del Rey, CA 90292-6905
Mailing address
PO Box 12212
Marina del Rey, CA 90295-3212
Phone (310) 486-0404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171026000851 | CA | Practitioner - Clinical Psychologist | 2567738149 | Practice locations: Marina del Rey, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY20104 | CA | MD | Clinical Psychologist |
| 20104 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673481600000",
"number": "1740705367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12212",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902953212",
"telephone_number": "310-486-0404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4712 ADMIRALTY WAY STE 591",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902926905",
"telephone_number": "310-850-1699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALASHOVA-SHAMIS",
"first_name": "ELENA",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-04",
"last_updated": "2023-01-12",
"certification_date": "2022-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY20104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marina del Rey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.