Active NPI
Shannon Black
- Developmental Therapist
- Tampa, FL
National Provider Identifier
1063948248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 550 N Reo St
Tampa, FL 33609-1061 - Phone
- (813) 374-2070
- Fax
- (813) 337-0937
- NPI assigned
- May 7, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
550 N Reo St
Tampa, FL 33609-1061
Mailing address
2681 Roosevelt Blvd
Apt 6107
Clearwater, FL 33760-2962
Phone (305) 619-5739
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494115200000",
"number": "1063948248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2681 ROOSEVELT BLVD",
"address_2": "APT 6107",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337602962",
"telephone_number": "305-619-5739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 N REO ST",
"city": "TAMPA",
"state": "FL",
"postal_code": "336091061",
"telephone_number": "813-374-2070",
"fax_number": "813-337-0937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-07",
"last_updated": "2017-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.