Active NPI
Carol Ann Shaver, EDD
- Clinical Neuropsychologist
- Stevensville, MI
National Provider Identifier
1265551642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 6301006049
- Practice address
- 5722 St Joseph Avenue
Stevensville, MI 49127 - Phone
- (269) 429-4148
- Fax
- (269) 429-6878
- NPI assigned
- Mar 28, 2007
- Last updated
- Jul 8, 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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 6301006049 | MI | Primary |
Addresses
Primary practice location
5722 St Joseph Avenue
Stevensville, MI 49127
Mailing address
5722 St Joseph Avenue
Stevensville, MI 49127
Phone (269) 429-4148
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 |
|---|---|---|---|
| 6301006049 | MI | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265551642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5722 ST JOSEPH AVENUE",
"city": "STEVENSVILLE",
"state": "MI",
"postal_code": "49127",
"telephone_number": "269-429-4148",
"fax_number": "269-429-6878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5722 ST JOSEPH AVENUE",
"city": "STEVENSVILLE",
"state": "MI",
"postal_code": "49127",
"telephone_number": "269-429-4148",
"fax_number": "269-429-6878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAVER",
"first_name": "CAROL",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "EDD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MI",
"license": "6301006049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stevensville, MI
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.