Provider Demographics
NPI:1760906317
Name:SHELTON PELOSI, JAMYE VICTORIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMYE
Middle Name:VICTORIA
Last Name:SHELTON PELOSI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCARLET KNIGHT WAY
Mailing Address - Street 2:RUTGERS UNIVERSITY HALE CENTER
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:732-445-8109
Mailing Address - Fax:
Practice Address - Street 1:1 SCARLET KNIGHT WAY
Practice Address - Street 2:RUTGERS UNIVERSITY HALE CENTER
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854
Practice Address - Country:US
Practice Address - Phone:732-445-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021416103TC0700X
NJ5721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical