Shoreline Pediatric Neuropsychological Services, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

2736 Issued in CT

Legal business name

SHORELINE PEDIATRIC NEUROPSYCHOLOGICAL SERVICES, LLC

Practice address

954 Middlesex Tpke
Ste A2
Old Saybrook, CT 06475-1302

Phone

(860) 388-2000

Fax

(860) 388-2000

NPI assigned

Sep 5, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shelley Frazier Pelletier, PH.D.

Title

Pediatric Neuropsychology

Phone

(860) 388-2000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428278400000",
    "number": "1992999767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 303",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "06475",
            "telephone_number": "860-388-2000",
            "fax_number": "860-388-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 MIDDLESEX TPKE",
            "address_2": "STE A2",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064751302",
            "telephone_number": "860-388-2000",
            "fax_number": "860-388-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE PEDIATRIC NEUROPSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2015-04-06",
        "status": "A",
        "authorized_official_last_name": "PELLETIER",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "FRAZIER",
        "authorized_official_title_or_position": "PEDIATRIC NEUROPSYCHOLOGY",
        "authorized_official_telephone_number": "860-388-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CT",
            "license": "2736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• Clinical Neuropsychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.