Shannon V Erklin, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

5431 Issued in NC

Practice address

211 E Six Forks Rd
Ste 114
Raleigh, NC 27609-7753

Phone

(919) 263-4177

NPI assigned

Jul 22, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 18, 2018 through Oct 18, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Psychiatry Practice & Associates, PLLC

  • Child & Adolescent Psychiatry Physician
  • Cary, NC
  • NPI 1588384572

  Clinical

  NPD
• Family Psychiatry and Psychology Associates, P.a.

  • Child & Adolescent Psychiatry Physician
  • Cary, NC
  • NPI 1932513223

  Clinical

  NPD (past)
• Patchwork Therapy, PLLC

  • Clinical Social Worker
  • Elmhurst, IL
  • NPI 1821673237
  NPD (past)

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

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1265710446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 BERGERON WAY",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275196669",
            "telephone_number": "919-263-4177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E SIX FORKS RD",
            "address_2": "STE 114",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097753",
            "telephone_number": "919-263-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERKLIN",
        "first_name": "SHANNON",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-22",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008673",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "5431",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071008673",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NC",
            "license": "5431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly McCrudden Erickson, MD
• Douglas Paul Ericson, MD
• Erin Decker Nutrition, LLC
• Erin Kelley Therapy PLLC
• Erin Rake, DDS, P.C.
• Alizabeth Ervin
• John Ervin, MSW, LCSWA, LCASA
• Wyandotta Michelle Ervin, LMHC-A
• Tara Meredith Escalante, LCSW
• Jeremiah Escarcega

• Clinical Child & Adolescent Psychologist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Child & Adolescent Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.