Provider Demographics
NPI:1811185440
Name:CONNER-SHEPHARD, MICHELE R I (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:R
Last Name:CONNER-SHEPHARD
Suffix:I
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:ROSE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:13 MOUNT CARMEL PL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1714
Mailing Address - Country:US
Mailing Address - Phone:845-452-6077
Mailing Address - Fax:845-452-6235
Practice Address - Street 1:13 MOUNT CARMEL PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1714
Practice Address - Country:US
Practice Address - Phone:845-452-6077
Practice Address - Fax:845-452-6235
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014520-01103TC2200X
NY014520103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent