Individual provider Active NPI

Shanee Fulton, M.S.

  • Speech-Language Pathologist
  • Alhambra, CA
National Provider Identifier
1073856654
Registry record updated Dec 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
8223 Issued in CA
Practice address
1423 S 3Rd St
Alhambra, CA 91803-3303
Phone
(213) 400-4447
NPI assigned
Apr 1, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 13152 NC
Speech-Language Pathologist 235Z00000X 004887 CT
Speech-Language Pathologist 235Z00000X 8223 CA Primary

Addresses

Primary practice location

1423 S 3Rd St
Alhambra, CA 91803-3303

Mailing address

1423 S 3Rd St
Alhambra, CA 91803-3303
Phone (213) 400-4447

Other practice location 1

8801 Fast Park Dr Ste 301
Raleigh, NC 27617-4853
Phone (213) 400-4447

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210714001175 CA Practitioner - Qualified Speech Language Pathologist 5496155491

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
21592CAMDClinical Psychologist
13152NCMDSpeech-Language Pathologist
004887CTMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Language to Learning, Inc Speech-Language Pathologist CurrentSince Mar 3, 2021 Accepting new patients
Sprout and Bloom Therapy Services PC Speech-Language Pathologist Current Accepting new patients

Locations

2130 Huntington Dr
Ste 211
South Pasadena, CA 91030
Phone (213) 400-4447

8801 Fast Park Dr
Ste 301
Raleigh, NC 27617
Phone (919) 589-2170

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734134400000",
    "number": "1073856654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 S 3RD ST",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918033303",
            "telephone_number": "213-400-4447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 S 3RD ST",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918033303",
            "telephone_number": "213-400-4447"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8801 Fast Park Dr Ste 301",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276174853",
            "country_code": "US",
            "telephone_number": "213-400-4447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULTON",
        "first_name": "SHANEE",
        "credential": "M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-01",
        "last_updated": "2024-12-14",
        "certification_date": "2024-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "13152",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "004887",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "8223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alhambra, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.