SHALENE ANN KENNEDY MD NPI 1043295876

NPI Information

NPI: 1043295876
Provider Name: SHALENE ANN KENNEDY, MD
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Individual

Specialization: Child & Adolescent Psychiatry

PECOS Registration: Yes

Address:
2040 WOODWINDS DR
WOODBURY, MN
ZIP 55125
Phone: (651) 259-9750
Get Directions

Shalene Ann Kennedy, MD is a child and adolescent psychiatry psychiatry neurology in Woodbury, MN with 29 years of experience. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. Shalene Ann Kennedy, MD NPI is 1043295876. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: CREIGHTON UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1995

The provider's business location address is:

2040 WOODWINDS DR
WOODBURY, MN
ZIP 55125-522
Phone: (651) 259-9750
Fax: (651) 259-9790

The NPI 1043295876 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/14/2005 and was last updated on 11/22/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry	38890	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	951485600	MEDICAID	MINNESOTA
2	991N6KE	OTHER	MINNESOTA	BCBS OF MN
3	1561501	OTHER	MINNESOTA	MEDICA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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