Active NPI
Shelly Denise Minor, PH.D
- Psychologist
- Bethel Island, CA
National Provider Identifier
1891977435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 21477
- Practice address
- 6327 Bethel Island Road
Suite a
Bethel Island, CA 94511-1011 - Phone
- (925) 550-0540
- Fax
- (925) 684-0348
- NPI assigned
- Dec 5, 2007
- Last updated
- Feb 17, 2011
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 21477 | CA | Primary |
Addresses
Primary practice location
6327 Bethel Island Road
Suite a
Bethel Island, CA 94511-1011
Mailing address
6327 Bethel Island Road Suite a
Bethel Island, CA 94511
Phone (925) 550-0540
Other names 1
- Ms. Shelly Denise Carpenter
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 |
|---|---|---|---|---|
| I20110525000662 | CA | Practitioner - Clinical Psychologist | 8729264882 | Practice locations: Bethel Island, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2004
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
6327 Bethel Island Rd
Suite a
Bethel Island, CA 94511-1011
Phone (925) 550-0540
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21477 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297900800000",
"number": "1891977435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6327 BETHEL ISLAND ROAD SUITE A",
"city": "BETHEL ISLAND",
"state": "CA",
"postal_code": "94511",
"telephone_number": "925-550-0540",
"fax_number": "925-684-0348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6327 BETHEL ISLAND ROAD",
"address_2": "SUITE A",
"city": "BETHEL ISLAND",
"state": "CA",
"postal_code": "945111011",
"telephone_number": "925-550-0540",
"fax_number": "925-684-0348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINOR",
"first_name": "SHELLY",
"middle_name": "DENISE",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-05",
"last_updated": "2011-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "21477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHELLY",
"last_name": "CARPENTER",
"middle_name": "DENISE",
"prefix": "MS.",
"credential": "PH.D",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bethel Island, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; 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.