Provider Demographics
NPI:1982732491
Name:SHIFF, SHIRLEY F (PSYD HSPP)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:F
Last Name:SHIFF
Suffix:
Gender:F
Credentials:PSYD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 VICTORIA WOODS PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6510
Mailing Address - Country:US
Mailing Address - Phone:260-489-0292
Mailing Address - Fax:260-489-3060
Practice Address - Street 1:8424 VICTORIA WOODS PL
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6510
Practice Address - Country:US
Practice Address - Phone:260-489-0292
Practice Address - Fax:260-489-3060
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100210420CMedicaid
INP00249943OtherRAILROAD MEDICARE
IN925940Medicare PIN