Active NPI
Shawn Jermaine Smalls, NURSE
- Licensed Practical Nurse
- Plymouth Meeting, PA
National Provider Identifier
1285995118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- L2-0010853
- Practice address
- 2250 Hickory Rd
Suite 240
Plymouth Meeting, PA 19462-1047 - Phone
- (302) 998-0469
- NPI assigned
- Jun 7, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L2-0010853 | DE | Primary |
| Licensed Practical Nurse | 164W00000X | PN278828 | PA |
Addresses
Primary practice location
2250 Hickory Rd
Suite 240
Plymouth Meeting, PA 19462-1047
Mailing address
2250 Hickory Rd
Suite 240
Plymouth Meeting, PA 19462-1047
Phone (610) 888-0588
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164W00000X | Other | DE | INDIVIDUAL PROVIDER |
| 164W00000X | Other | PA | INDIVIDUAL PROVIDER |
| 164W00000X | Other | MD | INDIVIDUAL PROVIDER |
Other names 1
- Mr. Shawn Smalls
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 |
|---|---|---|---|
| L2-0010853 | DE | MD | Licensed Practical Nurse |
| PN278828 | PA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383264000000",
"number": "1285995118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2250 HICKORY RD",
"address_2": "SUITE 240",
"city": "PLYMOUTH MEETING",
"state": "PA",
"postal_code": "194621047",
"telephone_number": "610-888-0588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2250 HICKORY RD",
"address_2": "SUITE 240",
"city": "PLYMOUTH MEETING",
"state": "PA",
"postal_code": "194621047",
"telephone_number": "302-998-0469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALLS",
"first_name": "SHAWN",
"middle_name": "JERMAINE",
"name_prefix": "Mr.",
"credential": "NURSE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-07",
"last_updated": "2013-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "DE",
"license": "L2-0010853",
"primary": true
},
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "PA",
"license": "PN278828",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL PROVIDER",
"identifier": "164W00000X",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL PROVIDER",
"identifier": "164W00000X",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL PROVIDER",
"identifier": "164W00000X",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHAWN",
"last_name": "SMALLS",
"prefix": "MR.",
"credential": "NURSE",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Plymouth Meeting, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.