Healthcare Provider Details

I. General information

NPI: 1881492692
Provider Name (Legal Business Name): SHENELLE FREDERICK PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MEDICAL GROUP UNIT 7095, BOX 185 BLDG. 865
APO AE
09824
US

IV. Provider business mailing address

39 MEDICAL GROUP UNIT 7095, BOX 185 BLDG. 865
APO AE
09824
US

V. Phone/Fax

Practice location:
  • Phone: 314-676-6452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY13278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: