Provider Demographics
NPI:1629183272
Name:KOSISKY, SHELLEY ANN
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ANN
Last Name:KOSISKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 FARLEY CT S
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2817
Mailing Address - Country:US
Mailing Address - Phone:410-626-7304
Mailing Address - Fax:
Practice Address - Street 1:528 COLLEGE PKWY STE H
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-4614
Practice Address - Country:US
Practice Address - Phone:410-757-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical