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General NPI Number Information
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NPI Number | 1912119843
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Entity Type | Individual
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Provider Name | SUSAN SHIVELY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 255 S 17TH ST SUITE 2710
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6231
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Country | US
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Telephone | 215-735-1554
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Fax | 215-732-5402
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Provider Business Mailing Address
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Address Line | 1900 RITTENHOUSE SQ APT 8B
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5767
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Country | US
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Telephone | 215-732-8355
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Fax | 215-732-5402
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | MD019586E
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License Number State | PA
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