Individual provider Active NPI

Danielle Frances Shedlock, OTR/L

  • Occupational Therapist
  • Edgewater, NJ
National Provider Identifier
1093426959
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
46TR01097000 Issued in NJ
Practice address
725 River Rd Ste 107B
Edgewater, NJ 07020-1149
Phone
(201) 770-7845
NPI assigned
Dec 12, 2022
Last updated
Sep 5, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 46TR01097000 NJ Primary

Addresses

Primary practice location

725 River Rd Ste 107B
Edgewater, NJ 07020-1149

Mailing address

402 Farnham Ave
Lodi, NJ 07644-1205
Phone (201) 693-8499

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230314001776 NJ Practitioner - Occupational Therapist in Private Practice 9739553736 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mobile PhysiocareGroup PAC ID 7416344650, 8 clinicians

Practice addresses (Care Compare)

40 Marquis CT
Edgewater, NJ 07020-2900
Phone (917) 826-7230

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
46TR01097000NJMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Prosynergy Physical Therapy LLC CurrentSince Jan 1, 2023 Accepting new patients
Mobile Physiocare CurrentSince Mar 15, 2023 Accepting new patients

Locations

1033 Clifton Ave
Ste 207
Clifton, NJ 07013
Phone (201) 906-2960

45 South Ave W
#101
Cranford, NJ 07016
Phone (908) 583-4391

45 South Ave W
Ste 101
Cranford, NJ 07016
Phone (908) 709-7300

725 River Rd
Ste 107B
Edgewater, NJ 07020
Phone (201) 770-7845

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1670803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1093426959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 FARNHAM AVE",
            "city": "LODI",
            "state": "NJ",
            "postal_code": "076441205",
            "telephone_number": "201-693-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 RIVER RD STE 107B",
            "city": "EDGEWATER",
            "state": "NJ",
            "postal_code": "070201149",
            "telephone_number": "201-770-7845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEDLOCK",
        "first_name": "DANIELLE",
        "middle_name": "FRANCES",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-12",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NJ",
            "license": "46TR01097000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewater, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.