Active NPI
Shankeertha S Quinn, D.M.D
- Dentist
- Jacksonville, FL
National Provider Identifier
1275985368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN 22098
- Practice address
- 12667 Beach Blvd Ste 103
Jacksonville, FL 32246-7346 - Phone
- (904) 204-1542
- Fax
- (904) 683-0359
- NPI assigned
- Jul 13, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN 22098 | FL | Primary |
Addresses
Primary practice location
12667 Beach Blvd Ste 103
Jacksonville, FL 32246-7346
Mailing address
12667 Beach Blvd Ste 103
Jacksonville, FL 32246-7346
Phone (904) 204-1542
Other names 1
- Dr. Shankeertha Sundaralingam
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Jacksonville | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160927002877 | FL | Order and Referring Only - Dentist | 9739476235 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 22098 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644796800000",
"number": "1275985368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12667 BEACH BLVD STE 103",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322467346",
"telephone_number": "904-204-1542",
"fax_number": "904-683-0359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12667 BEACH BLVD STE 103",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322467346",
"telephone_number": "904-204-1542",
"fax_number": "904-683-0359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUINN",
"first_name": "SHANKEERTHA",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-13",
"last_updated": "2022-02-14",
"certification_date": "2022-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN 22098",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Jacksonville",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "12667 Beach Blvd Ste 103",
"city": "Jacksonville",
"state": "FL",
"country_code": "US",
"postal_code": "322467346",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "SHANKEERTHA",
"last_name": "SUNDARALINGAM",
"prefix": "DR.",
"credential": "DMD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.