Active NPI
Shanna Sanders
- Professional Counselor
- Charlotte, NC
National Provider Identifier
1063993491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- A14015
- Practice address
- 5624 Executive Center Dr Ste 105
Charlotte, NC 28212-8868 - Phone
- (704) 379-1960
- NPI assigned
- Aug 23, 2018
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | A14015 | NC | Primary |
Addresses
Primary practice location
5624 Executive Center Dr Ste 105
Charlotte, NC 28212-8868
Mailing address
9205 Bengali Cir Lot 208
Charlotte, NC 28213-5230
Phone (704) 222-0703
Other practice location 1
5104 Reagan Dr Ste 5
Charlotte, NC 28206
Phone (704) 596-0505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 25, 2024 through Apr 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A14015 | NC | MD | Professional Counselor |
| 14015 | NC | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572825600000",
"number": "1063993491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9205 BENGALI CIR LOT 208",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282135230",
"telephone_number": "704-222-0703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5624 EXECUTIVE CENTER DR STE 105",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282128868",
"telephone_number": "704-379-1960"
}
],
"practiceLocations": [
{
"address_1": "5104 Reagan Dr Ste 5",
"address_purpose": "LOCATION",
"city": "Charlotte",
"state": "NC",
"postal_code": "28206",
"country_code": "US",
"telephone_number": "704-596-0505",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SANDERS",
"first_name": "SHANNA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-23",
"last_updated": "2019-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "A14015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.