Provider Demographics
NPI:1215056460
Name:PEERY, SHELLEY (PHD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:PEERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SANSOME ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-1304
Mailing Address - Country:US
Mailing Address - Phone:415-218-6915
Mailing Address - Fax:415-561-6759
Practice Address - Street 1:1199 BUSH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5999
Practice Address - Country:US
Practice Address - Phone:415-218-6915
Practice Address - Fax:415-561-6759
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016257103G00000X
CA21904103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016257OtherPSYCHOLOGY LICENSE
CA21904OtherPSYCHOLOGY LICENSE