Shedrack Anderson

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

License

56744 Issued in TX

Practice address

13601 Preston View Blvd
Suite.E620
Dallas, TX 75240

Phone

(469) 885-8607

NPI assigned

Feb 7, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

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": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1134825474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13601 PRESTON VIEW BLVD",
            "address_2": "SUITE.E620",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75240",
            "telephone_number": "469-885-8607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13601 PRESTON VIEW BLVD",
            "address_2": "SUITE.E620",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75240",
            "telephone_number": "469-885-8607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "SHEDRACK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173C00000X",
            "taxonomy_group": "",
            "desc": "Reflexologist",
            "state": "TX",
            "license": "2243",
            "primary": false
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "CA",
            "license": "57334",
            "primary": false
        },
        {
            "code": "225600000X",
            "taxonomy_group": "",
            "desc": "Dance Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225A00000X",
            "taxonomy_group": "",
            "desc": "Music Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "TX",
            "license": "56744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Anderson
• Sara Elizabeth Anderson, PT
• Sarah Anderson, PT
• Scott Richard Anderson, MD
• Shanta Anderson, PHARMD
• Shelby Alyse Anderson, OD
• Shelby Sutton Anderson, PHARMD
• Sherry Anderson
• Sophie Emma Anderson
• Sophie McCannon Anderson, FNP

• Health & Wellness Coach in Dallas, TX
• Providers in Dallas, TX by specialty
• Health & Wellness Coach in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.