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General NPI Number Information
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NPI Number | 1164605317
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Entity Type | Individual
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Provider Name | ANDREW RYAN SHELLEY PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 1400 BLACKHORSE HILL RD
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City | COATESVILLE
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State | PA
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Zip | 19320-2040
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Country | US
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Telephone | 937-430-5460
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 ALLAN LN
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City | WEST CHESTER
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State | PA
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Zip | 19380-5802
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Country | US
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Telephone | 937-430-5460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4335
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License Number State | AZ
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