Provider Demographics
NPI:1043311095
Name:BALL, SHELLENE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHELLENE
Middle Name:MARIE
Last Name:BALL
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 1:73 GREENTREE DR # 340
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7646
Mailing Address - Country:US
Mailing Address - Phone:302-289-6757
Mailing Address - Fax:302-487-0572
Practice Address - Street 1:27 HAGGIS RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8753
Practice Address - Country:US
Practice Address - Phone:302-289-6757
Practice Address - Fax:302-487-0572
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical