Shannon Bennett-Gunderson

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95005012 Issued in CA

Practice address

5717 Pacific Center Blvd Ste 200
San Diego, CA 92121-4250

Phone

(858) 859-1188

NPI assigned

Mar 19, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557446400000",
    "number": "1073054334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7875 HIGHLAND VILLAGE PL",
            "address_2": "B102-244",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921295189",
            "telephone_number": "858-688-6968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5717 PACIFIC CENTER BLVD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921214250",
            "telephone_number": "858-859-1188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7875 Highland Village Pl",
            "address_2": "B102-244",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921295189",
            "country_code": "US",
            "telephone_number": "858-688-6968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENNETT-GUNDERSON",
        "first_name": "SHANNON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-19",
        "last_updated": "2019-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "536000",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95005012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelley Joyce Benn
• Dawn Benner
• Jon Michael Benner, PHARM.D
• Bennett Dental Corporation (Apnea & Breathing Clinic Bennett Dental Group)
• Patti A Bennett-Deguzman, LCSW
• Alexandra Sloane Bennett, LCSW
• Amy Kristina Bennett, RN, NP
• Andrew Kenneth Bennett, RADT
• Bessie Bennett
• Brenda E Bennett, LMFT

• Family Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.