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General NPI Number Information
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NPI Number | 1881864981
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Entity Type | Individual
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Provider Name | SHALONDA KELLY PHD
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Gender | Female
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 166 BUNN DR SUITE 105
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City | PRINCETON
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State | NJ
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Zip | 08540-2800
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Country | US
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Telephone | 609-921-2551
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Fax | 609-921-2298
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Provider Business Mailing Address
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Address Line | 152 FRELINGHUYSEN RD GSAPP - RUTGERS UNIVERSITY
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City | PISCATAWAY
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State | NJ
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Zip | 08854-8020
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Country | US
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Telephone | 732-445-2000
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Fax | 732-445-4888
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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 | 35 SI 00434600
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License Number State | NJ
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