Shane David Nibley

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

3079 Harrison Ave
South Lake Tahoe, CA 96150-7976

Phone

(530) 957-6254

NPI assigned

Nov 1, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1761955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1255200846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 SUNRISE AVE STE 300",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614144",
            "telephone_number": "916-783-5207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3079 HARRISON AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507976",
            "telephone_number": "530-957-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIBLEY",
        "first_name": "SHANE",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-01",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Neiger, PT
• Megan Seleine Neumann, LCSW
• Nancy NG, PHYSICAL THERAPIST
• Anh T Ngo, RPH
• Lam Nhat Nguyen, DDS
• Nicole H. Buell, D.D.S. Inc.
• Nicole M Jane, DDS, Ms, PC
• Stepanie Ann Niederman, L.AC., DIPL. OF ACUP
• Elisabeth Nigrini, MD
• Peter Nocka

• Rehabilitation Practitioner in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Rehabilitation Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.