Active NPI
Kelly Shelby
- Professional Counselor
- Hayward, CA
National Provider Identifier
1902287543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P0810281124
- Practice address
- 16929 Harvard Ave
Hayward, CA 94541-1350 - Phone
- (510) 496-5140
- Fax
- (510) 496-5146
- NPI assigned
- Jun 9, 2015
- 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 | P0810281124 | CA | Primary |
Addresses
Primary practice location
16929 Harvard Ave
Hayward, CA 94541-1350
Mailing address
1290 26TH Avenue
Oakland, CA 94601
Phone (510) 496-5140
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P0810281124 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582848000000",
"number": "1902287543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1290 26TH AVENUE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "94601",
"telephone_number": "510-496-5140",
"fax_number": "510-496-5146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16929 HARVARD AVE",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945411350",
"telephone_number": "510-496-5140",
"fax_number": "510-496-5146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELBY",
"first_name": "KELLY",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-09",
"last_updated": "2020-02-28",
"certification_date": "2020-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "P0810281124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hayward, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.