Shelley Lynn Sandbulte, EDD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

311 Issued in SD

Practice address

2210 S Brown PL
Sioux Falls, SD 57105-6582

Phone

(605) 332-1700

Fax

(605) 336-9031

NPI assigned

Aug 31, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Shelley L Pederson Former name

Medicare fee-for-service enrollment

Enrolled in SD

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

Specialty

Clinical Psychologist

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Sandbulte LLC

  • Psychologist
  • Sioux Falls, SD
  • NPI 1184303208
  Medicare reassignment NPD Authorized official
• Family Service, Inc.

  • Mental Health Counselor
  • Sioux Falls, SD
  • NPI 1003961145
  Medicare reassignment NPD
• Sandbulte Inc

  • Psychologist
  • Sioux Falls, SD
  • NPI 1366563215
  NPD (past) Authorized official
• Eggleston, Inc

  • Mental Health Counselor
  • Sioux Falls, SD
  • NPI 1891918033
  NPD
• Bunkers Inc

  • Clinical Social Worker
  • Sioux Falls, SD
  • NPI 1750400537
  NPD (past)

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330905600000",
    "number": "1871587253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 S BROWN PL",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056582",
            "telephone_number": "605-332-1700",
            "fax_number": "605-336-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 S BROWN PL",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571056582",
            "telephone_number": "605-332-1700",
            "fax_number": "605-336-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDBULTE",
        "first_name": "SHELLEY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "EDD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-31",
        "last_updated": "2012-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "SD",
            "license": "311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6550683",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLEY",
            "last_name": "PEDERSON",
            "middle_name": "L",
            "prefix": "DR.",
            "credential": "ED.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sanctuary, LLC
• Kendra Sandal
• Sandbulte Inc
• Sandbulte LLC
• Baylee Sandbulte
• Breanne Maray Sande Russell, PHD
• Davida Nicole Sheree Sande Russell, LGSW,CSW
• Ashley Renee Sandeen, D.O.
• Malcom S Sanders, MD
• Morgan Joy Sandersfeld

• Psychologist in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Psychologist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.