MEDICARE: DR. SHELLAH MYRA IMPERIO PH. 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
1	103TC1900X	Counseling Psychologist	PY60084605	WA

General Provider Information

NPI Number	:	1952440281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLAH MYRA IMPERIO PH. D.

Provider Business Mailing Address
First Line	:	1415 S 3RD ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-4905
Country	:	US
Telephone Number	:	425-243-4378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 S 3RD ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-4905
Country	:	US
Telephone Number	:	425-243-4378
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	06/17/2026

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