Provider Demographics
NPI:1144779919
Name:SHELLY, SUSAN (MA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:SHELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:62 N CHURCH ST # A
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4397
Mailing Address - Country:US
Mailing Address - Phone:267-410-9637
Mailing Address - Fax:
Practice Address - Street 1:62 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4397
Practice Address - Country:US
Practice Address - Phone:267-377-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty