DR. MIRA B SHORE PSYD.
NPI 1750079067
Psychologist in Philadelphia, PA

Active since April 25, 2023PECOS EnrolledAccepts Medicare Assignment
850 N 11TH ST, PHILADELPHIA, PA 19123(267) 597-3604 Get Directions Write a Review

NPPES record last updated: February 12, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Mira B Shore Psyd. NPPES

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

DR. MIRA B SHORE PSYD. (NPI 1750079067) is an individual psychologist in Philadelphia, Pennsylvania and active in the NPI registry since April 2023. She is enrolled in Medicare PECOS, maintains a secondary practice location in Sharon Hill, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1750079067
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. MIRA B SHORECredential: PSYD.
Location Address850 N 11TH STPhiladelphia, PA 19123-1957
Mailing Address921 Chester PikeSharon Hill, PA 19079-1411 · (610) 639-0795
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateApril 25, 2023
Last NPPES UpdateFebruary 12, 2026
NPPES CertifiedFebruary 12, 2026
NPI 1750079067 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedCounselorTaxonomy 101Y00000X
850 N 11TH ST, Philadelphia, PA 19123

Secondary Practice Location 1

Location 1921 Chester PikeSharon Hill, PA 19079-1411 · Phone (610) 583-3500

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Mira B Shore Psyd. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3274064019
PECOS Enrollment IDI20241003001289
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 20

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

Counselor (Professional)
850 N 11TH ST, STEPHEN & SANDRA SHELLER 11TH STREET FAMILY HEALTH SERV
PHILADELPHIA, PA 19123
Psychologist (Clinical)
850 N 11TH ST
PHILADELPHIA, PA 19123
Social Worker (Clinical)
850 N 11TH ST
PHILADELPHIA, PA 19123
Nurse Practitioner (Psychiatric/Mental Health)
850 N 11TH ST
PHILADELPHIA, PA 19123
Nurse Practitioner
850 N 11TH ST
PHILADELPHIA, PA 19123
Nurse Practitioner
850 N 11TH ST
PHILADELPHIA, PA 19123
Physical Therapist
850 N 11TH ST
PHILADELPHIA, PA 19123
Clinic/Center
850 N 11TH ST
PHILADELPHIA, PA 19123

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 Mira Shore's NPI number?

The NPI number for Mira Shore is 1750079067. It was assigned to this individual provider in the NPPES registry on April 25, 2023.

Where is Mira Shore located?

Mira Shore practices at 850 N 11th St, Philadelphia, PA 19123. The listed phone number is (267) 597-3604.

What is Mira Shore's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Mira Shore enrolled in Medicare?

Yes. Mira Shore is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Mira Shore was last updated on February 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.