Shannon Cornell, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Practice address

6525 2ND Ave
Detroit, MI 48202-3006

Phone

(313) 972-4060

NPI assigned

Mar 24, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: scornell504400@direct.hfhs.org

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1164008520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6525 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023006",
            "telephone_number": "313-972-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELL",
        "first_name": "SHANNON",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-24",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.mychart.com",
            "affiliation": "N",
            "address_1": "6525 2nd Ave",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482023006",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "scornell504400@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "6525 2nd Ave",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482023006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapy Assistant in Detroit, MI
• Providers in Detroit, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; 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.