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SHELBY L BLACKLEY
NPI 1518584259
Physician Assistant - Surgical in Trumbull, CT

Active since June 29, 2020PECOS Enrolled
5520 PARK AVE STE WP-2300, TRUMBULL, CT 06611(203) 374-0310 Get Directions Write a Review

NPPES record last updated: October 1, 2025. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Jun 6, 2024, Jun 29, 2020 (2 updates tracked since 2020).

About Shelby L Blackley NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHELBY L BLACKLEY (NPI 1518584259) is an individual surgical provider in Trumbull, Connecticut, licensed in Connecticut (4908) and active in the NPI registry since June 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1518584259
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameSHELBY L BLACKLEY
Location Address5520 PARK AVE STE WP-2300Trumbull, CT 06611-3463
Mailing Address60 Metropolitan Park DrRiverside, RI 02915-2150 · (508) 463-7929
Phone(203) 374-0310
Sole ProprietorNo
Enumeration DateJune 29, 2020
Last NPPES UpdateOctober 1, 20252 updates tracked since enumeration
NPPES CertifiedOctober 1, 2025
✔ NPI 1518584259 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in CT · 4908
5520 PARK AVE STE WP-2300, Trumbull, CT 06611
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shelby L Blackley is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. ALLISON ROSE MASTROIANNI PA
Physician Assistant
5520 PARK AVE STE WP-2300
TRUMBULL, CT 06611
Greater Bridgeport Planning Region (203) 374-0310
THE DIEP GROUP CT PLLC
Plastic Surgery
5520 PARK AVE STE WP-2300
TRUMBULL, CT 06611
Greater Bridgeport Planning Region (203) 374-0310
ALICIA MARIE ANDALORO PA-C
Physician Assistant
5520 PARK AVE STE WP-2300
TRUMBULL, CT 06611
Greater Bridgeport Planning Region (203) 290-2940

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shelby Blackley's NPI number?

The NPI number for Shelby Blackley is 1518584259. It was assigned to this individual provider in the NPPES registry on June 29, 2020.

Where is Shelby Blackley located?

Shelby Blackley practices at 5520 Park Ave Ste Wp-2300, Trumbull, CT 06611. The listed phone number is (203) 374-0310.

What is Shelby Blackley's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Shelby Blackley enrolled in Medicare?

Yes. Shelby Blackley is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Shelby Blackley was last updated on October 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.