Active NPI
Shawn Dwayne Terry, COMMERCIAL DRIVER
- Vehicle Modifications Contractor
- Cincinnati, OH
National Provider Identifier
1194415513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vehicle Modifications Contractor
- License
- RN915945
- Practice address
- 5120 Broerman Ave Apt B4
Cincinnati, OH 45217-1136 - Phone
- (513) 687-3940
- NPI assigned
- May 9, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Vehicle Modifications Contractor | 171WV0202X | RN915945 | OH | Primary |
Addresses
Primary practice location
5120 Broerman Ave Apt B4
Cincinnati, OH 45217-1136
Mailing address
5120 Broerman Ave Apt B4
Cincinnati, OH 45217-1136
Phone (513) 687-3940
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 |
|---|---|---|---|
| RN915945 | OH | MD | Vehicle Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683590400000",
"number": "1194415513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5120 BROERMAN AVE APT B4",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452171136",
"telephone_number": "513-687-3940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5120 BROERMAN AVE APT B4",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452171136",
"telephone_number": "513-687-3940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TERRY",
"first_name": "SHAWN",
"middle_name": "DWAYNE",
"credential": "COMMERCIAL DRIVER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-09",
"last_updated": "2023-05-09",
"certification_date": "2023-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "171WV0202X",
"taxonomy_group": "",
"desc": "Contractor, Vehicle Modifications",
"state": "OH",
"license": "RN915945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.