Provider Demographics
NPI:1922349612
Name:SHELLEY, ANDREA (PSY-D)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:PSY-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330251
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-0251
Mailing Address - Country:US
Mailing Address - Phone:415-515-3211
Mailing Address - Fax:714-739-4008
Practice Address - Street 1:1757 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4447
Practice Address - Country:US
Practice Address - Phone:415-515-3211
Practice Address - Fax:714-739-4008
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical