Provider Demographics
NPI:1710191549
Name:SHELOV, MARSHA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:L
Last Name:SHELOV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1802
Mailing Address - Country:US
Mailing Address - Phone:914-725-0169
Mailing Address - Fax:914-725-7245
Practice Address - Street 1:12 BROAD ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1401
Practice Address - Country:US
Practice Address - Phone:914-725-0169
Practice Address - Fax:914-725-7245
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical