MEDICARE: EDWIN R SHIRLEY PHD

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
1	103T00000X	Psychologist	5288	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	620006108	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000224328	OTHER	OH	UNISON
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000532989	OTHER	OH	ANTHEM
6	7310626	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1376563650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN R SHIRLEY PHD

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10524 EUCLID AVE FL 12
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2205
Country	:	US
Telephone Number	:	216-844-2400
Fax Number	:	216-844-2877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/06/2021

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Directions to “ EDWIN R SHIRLEY PHD” Practice Location

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