Shane C Hernesman MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME83457 Issued in FL

Legal business name

SHANE C HERNESMAN MD PA

Practice address

505 Delannoy Ave
Cocoa, FL 32922-7813

Phone

(321) 631-4940

Fax

(321) 631-4941

NPI assigned

Apr 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shane C Hernesman, MDNPI 1952412652

Title

President

Phone

(321) 631-4940

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shane Christopher Hernesman, MD

  • Family Medicine Physician
  • Merritt Island, FL
  • NPI 1952412652

  Family Medicine, FL

  Medicare reassignment NPD Authorized official
• Cori Megan Daniels, NP

  • Nurse Practitioner
  • Merritt Island, FL
  • NPI 1033464441
  NPD

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164545620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 DELANNOY AVE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329227813",
            "telephone_number": "321-631-4940",
            "fax_number": "321-631-4941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 DELANNOY AVE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329227813",
            "telephone_number": "321-631-4940",
            "fax_number": "321-631-4941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE C HERNESMAN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HERNESMAN",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-631-4940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME83457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Joy Selwach, DO, MBA
• Elyssia Marie Semenec
• Jennifer Seo, B.S, BCABA
• Yvner Servius
• Tiffany Nicole Setliff
• Sharing Facility Inc 2
• Sharon a. Jones LLC
• Laura Sharpe
• Mohamed B Shawi, DMD
• Shelly Adamson Counseling LLC

• Family Medicine Physician in Cocoa, FL
• Providers in Cocoa, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.