Provider Demographics
NPI:1841558616
Name:AMEN, SHELLEY L (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:L
Last Name:AMEN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VA CT HEALTHCARE SYSTEM
Mailing Address - Street 2:950 CAMPBELL AVE, BLDG 35
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516
Mailing Address - Country:US
Mailing Address - Phone:203-932-5722
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST # T-209
Practice Address - Street 2:YALE-NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2259
Practice Address - Fax:203-688-5599
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT530392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry