Provider Demographics
NPI:1427048362
Name:GRIFFIN-SHELLEY, ERIC EUGENE SR (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EUGENE
Last Name:GRIFFIN-SHELLEY
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MATTISON AVE APT 3003
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4643
Mailing Address - Country:US
Mailing Address - Phone:610-828-4298
Mailing Address - Fax:610-943-2322
Practice Address - Street 1:452 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1805
Practice Address - Country:US
Practice Address - Phone:610-828-4298
Practice Address - Fax:610-943-2322
Is Sole Proprietor?:No
Enumeration Date:2005-10-23
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003909-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA41-1400070Medicaid
PAR06363Medicare UPIN
PA154972Medicare ID - Type Unspecified