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NPI Code Detail

MEDICARE: DR. CHELSAE ROBY PISTELLO PSY.D.

MEDICARE: DR. CHELSAE ROBY PISTELLO PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist

General Provider Information

NPI Number : 1215338249
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHELSAE ROBY PISTELLO PSY.D.
Provider Business Mailing Address
First Line : 5705 OAK VALLEY RD
Second Line :
City : DAYTON
State : OH
Zip : 45440-2325
Country : US
Telephone Number : 314-578-8453
Fax Number :
Provider Business Practice Location Address
First Line : 5705 OAK VALLEY RD
Second Line :
City : DAYTON
State : OH
Zip : 45440-2325
Country : US
Telephone Number : 314-578-8453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2014
Last Update Date : 12/01/2023

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