Active NPI
Shawn Waddell
- Counselor
- San Antonio, TX
National Provider Identifier
1134987993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- R1451161221
- Practice address
- 7915 Melbury FRST
San Antonio, TX 78239-3204 - Phone
- (818) 466-4878
- NPI assigned
- Mar 7, 2024
- Last updated
- Mar 7, 2024
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | R1451161221 | CA | Primary |
Addresses
Primary practice location
7915 Melbury FRST
San Antonio, TX 78239-3204
Mailing address
7915 Melbury FRST
San Antonio, TX 78239-3204
Other practice location 1
1800 Vine St
Los Angeles, CA 90028-5250
Phone (818) 466-4875
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1451161221 | CA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709769600000",
"number": "1134987993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7915 MELBURY FRST",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782393204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7915 MELBURY FRST",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782393204",
"telephone_number": "818-466-4878"
}
],
"practiceLocations": [
{
"address_1": "1800 Vine St",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900285250",
"country_code": "US",
"telephone_number": "818-466-4875",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WADDELL",
"first_name": "SHAWN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-07",
"last_updated": "2024-03-07",
"certification_date": "2024-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "R1451161221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.