Provider Demographics
NPI:1881864981
Name:KELLY, SHALONDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHALONDA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:152 FRELINGHUYSEN RD
Mailing Address - Street 2:GSAPP - RUTGERS UNIVERSITY
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-8020
Mailing Address - Country:US
Mailing Address - Phone:732-445-2000
Mailing Address - Fax:732-445-4888
Practice Address - Street 1:166 BUNN DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2800
Practice Address - Country:US
Practice Address - Phone:609-921-2551
Practice Address - Fax:609-921-2298
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35 SI 00434600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical