Active NPI
Jordan Shangreaux, MS, LAT, ATC
- Athletic Trainer
- Aberdeen, SD
National Provider Identifier
1104366475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0472
- Practice address
- 2200 S Roosevelt St
Aberdeen, SD 57401 - Phone
- (605) 280-4697
- NPI assigned
- Mar 6, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0472 | SD | Primary |
Addresses
Primary practice location
2200 S Roosevelt St
Aberdeen, SD 57401
Mailing address
1736 S 2ND St
Aberdeen, SD 57401-7416
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0472 | SD | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576800000000",
"number": "1104366475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1736 S 2ND ST",
"city": "ABERDEEN",
"state": "SD",
"postal_code": "574017416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 S ROOSEVELT ST",
"city": "ABERDEEN",
"state": "SD",
"postal_code": "57401",
"telephone_number": "605-280-4697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANGREAUX",
"first_name": "JORDAN",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-06",
"last_updated": "2019-12-20",
"certification_date": "2019-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "SD",
"license": "0472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aberdeen, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.