Provider Demographics
NPI:1669355814
Name:NYSTROM, SHELLEY ROYE (MA)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ROYE
Last Name:NYSTROM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 UNIVERSITY AVE W STE 425
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3598
Mailing Address - Country:US
Mailing Address - Phone:651-212-5288
Mailing Address - Fax:612-677-3736
Practice Address - Street 1:1919 UNIVERSITY AVE W STE 425
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3598
Practice Address - Country:US
Practice Address - Phone:651-212-5288
Practice Address - Fax:612-677-3736
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist