Ismely Shannon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW12247 Issued in FL

Practice address

379 6TH Ave W
Bradenton, FL 34205-8820

Phone

(941) 782-4100

Fax

(941) 782-4101

NPI assigned

May 27, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ismely.shannon.1@24284.direct.athenahealth.com
• Direct secure messaging: ismely.shannon.1@17026.direct.athenahealth.com

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.

• Centerstone of Florida, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bradenton, FL
  • NPI 1144251638
  Medicare reassignment
• Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Princeville, IL
  • NPI 1336767540
  NPD
• Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Urbana, IL
  • NPI 1396154076
  NPD
• Community Health Partnership of Illinois

  • Federally Qualified Health Center (FQHC)
  • Aurora, IL
  • NPI 1932375169
  NPD
• Centerstone of Florida, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sarasota, FL
  • NPI 1033789052
  NPD (past)

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1154640381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9478",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342069478",
            "telephone_number": "941-782-4299",
            "fax_number": "941-782-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "379 6TH AVE W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342058820",
            "telephone_number": "941-782-4100",
            "fax_number": "941-782-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "ISMELY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-27",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW12247",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucas J Shallenberger
• Renat Shamiev, PHARMD
• Amirra Gisselle Shamma
• Sean Dien Shanahan, DPM
• Stephen Shanklin, DO
• Kimberly Evette Shannon, RPH
• Lisa Shannon, D.O.
• Mikala Shannon
• Todd A Shapiro, LCSW, MPA
• Vishakha Sharma

• Clinical Social Worker in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.