Provider Demographics
NPI:1770880833
Name:ROYALTY, SHELLY (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:ROYALTY
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 1:325 CARLSBAD VILLAGE DR
Mailing Address - Street 2:STE. F2
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2928
Mailing Address - Country:US
Mailing Address - Phone:760-688-0110
Mailing Address - Fax:
Practice Address - Street 1:325 CARLSBAD VILLAGE DR
Practice Address - Street 2:STE. F2
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2928
Practice Address - Country:US
Practice Address - Phone:760-688-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21020103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling