Active NPI
Jahnavi June Shields, LIC PSYCHIATRIC TECH
- Counselor
- Santa Rosa, CA
National Provider Identifier
1174741185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- PT 15082
- Practice address
- 634 Pressley St
Santa Rosa, CA 95404-5526 - Phone
- (707) 573-6955
- Fax
- (707) 543-8176
- NPI assigned
- Apr 23, 2007
- Sex
- Female
- 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 | PT 15082 | CA | Primary |
Addresses
Primary practice location
634 Pressley St
Santa Rosa, CA 95404-5526
Mailing address
13 Creekwood SQ
Rohnert Park, CA 94928-2781
Phone (707) 237-6118
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811 | Other | CA | COUNSELOR |
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 |
|---|---|---|---|
| PT 15082 | CA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174741185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 CREEKWOOD SQ",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282781",
"telephone_number": "707-237-6118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "634 PRESSLEY ST",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954045526",
"telephone_number": "707-573-6955",
"fax_number": "707-543-8176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "JAHNAVI",
"middle_name": "JUNE",
"name_prefix": "Ms.",
"credential": "LIC PSYCHIATRIC TECH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "PT 15082",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNSELOR",
"identifier": "1811",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.