Active NPI
Justin Shedivy
- Counselor
- New Brighton, MN
National Provider Identifier
1174807333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786 - Phone
- (651) 628-9566
- NPI assigned
- Oct 6, 2011
- 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 | Primary |
Addresses
Primary practice location
1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786
Mailing address
1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1786
Phone (651) 628-9566
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317859200000",
"number": "1174807333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 SILVER LAKE RD NW",
"address_2": "SUITE 110",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "551121786",
"telephone_number": "651-628-9566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 SILVER LAKE RD NW",
"address_2": "SUITE 110",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "551121786",
"telephone_number": "651-628-9566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEDIVY",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-06",
"last_updated": "2011-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Brighton, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.