Active NPI
Shannon N Sandstrom, NP
- Adult Health Nurse Practitioner
- Randolph, WI
National Provider Identifier
1194778324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 2722
- Practice address
- 137 Cambria St
Randolph, WI 53956 - Phone
- (920) 326-5303
- NPI assigned
- May 18, 2006
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 2722 | WI | Primary |
Addresses
Primary practice location
137 Cambria St
Randolph, WI 53956
Mailing address
420 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-8340
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2722 | WI | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1194778324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 E DIVISION ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549354560",
"telephone_number": "920-926-8340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 CAMBRIA ST",
"city": "RANDOLPH",
"state": "WI",
"postal_code": "53956",
"telephone_number": "920-326-5303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDSTROM",
"first_name": "SHANNON",
"middle_name": "N",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-18",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "WI",
"license": "2722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.