Susan Shively, M.D.

Primary specialty

PsychoanalystTaxonomy code 102L00000X

License

MD019586E Issued in PA

Practice address

255 S 17TH St
Suite 2710
Philadelphia, PA 19103-6231

Phone

(215) 735-1554

Fax

(215) 732-5402

NPI assigned

May 4, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912119843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 RITTENHOUSE SQ",
            "address_2": "APT 8B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191035767",
            "telephone_number": "215-732-8355",
            "fax_number": "215-732-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 S 17TH ST",
            "address_2": "SUITE 2710",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191036231",
            "telephone_number": "215-735-1554",
            "fax_number": "215-732-5402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "",
            "desc": "Psychoanalyst",
            "state": "PA",
            "license": "MD019586E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Shissler, PA-C
• Shiva Om LLC
• Poojita Shivamurthy, MD
• Raina Shivashankar, MD
• Matthew Shive, LPC
• Tariq Shivji, M.D.
• Richard David Shlansky-Goldberg, MD
• Anatoly Shlobin, PT
• Erica L Shmilovich, LPC
• Amber I Shmuckler, MFT

• Psychoanalyst in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychoanalyst in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.