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NPI Code Detail

MEDICARE: MR. JAY R SHETLER PSYD, HSPP

MEDICARE: MR. JAY R SHETLER PSYD, HSPP
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
1103TC0700XClinical Psychologist20041401AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962429654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAY R SHETLER PSYD, HSPP
Provider Business Mailing Address
First Line : 1930 W LINCOLN AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-5907
Country : US
Telephone Number : 574-534-2161
Fax Number : 574-534-3887
Provider Business Practice Location Address
First Line : 1930 W LINCOLN AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-5907
Country : US
Telephone Number : 574-534-2161
Fax Number : 574-534-3887
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 10/02/2008

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