Active NPI
Jeannette Shupe, MS
- Speech-Language Pathologist
- Rock Tavern, NY
National Provider Identifier
1336517671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 006764
- Practice address
- 8 Maclean Dr
Rock Tavern, NY 12575-0121 - Phone
- (845) 258-0139
- NPI assigned
- Sep 3, 2015
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 006764 | NY | Primary |
Addresses
Primary practice location
8 Maclean Dr
Rock Tavern, NY 12575-0121
Mailing address
PO Box 121
8 Maclean Dr
Rock Tavern, NY 12575-0121
Phone (845) 258-0139
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006764 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441238400000",
"number": "1336517671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 121",
"address_2": "8 MACLEAN DR",
"city": "ROCK TAVERN",
"state": "NY",
"postal_code": "125750121",
"telephone_number": "845-258-0139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 MACLEAN DR",
"city": "ROCK TAVERN",
"state": "NY",
"postal_code": "125750121",
"telephone_number": "845-258-0139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUPE",
"first_name": "JEANNETTE",
"name_prefix": "Mrs.",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-03",
"last_updated": "2015-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "006764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rock Tavern, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.