Provider Demographics
NPI:1831541069
Name:SHELLEY S KAUFMAN PC
Entity type:Organization
Organization Name:SHELLEY S KAUFMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-257-0560
Mailing Address - Street 1:PO BOX 10863
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-0863
Mailing Address - Country:US
Mailing Address - Phone:602-257-0560
Mailing Address - Fax:
Practice Address - Street 1:17505 N 79TH AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8725
Practice Address - Country:US
Practice Address - Phone:602-257-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZPHD1389OtherPTAN