Shanedas Time to Care LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

SHANEDAS TIME TO CARE LLC

Practice address

6233 NW Gisela St
Port Saint Lucie, FL 34986-3866

Phone

(772) 777-9827

NPI assigned

Oct 31, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Shaneada Vancol I

Title

Owner

Phone

(772) 501-6619

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shaneada vancol Former legal business name

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

{
    "created_epoch": "1509408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1336651207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1881 SW ELIJAH AVE",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349533495",
            "telephone_number": "772-501-6619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6233 NW GISELA ST",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349863866",
            "telephone_number": "772-777-9827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANEDAS TIME TO CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-31",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "VANCOL",
        "authorized_official_first_name": "SHANEADA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-501-6619",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_name_suffix": "I"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022855600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shaneada vancol",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Shaneada vancol",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Developmental Disabilities Clinic/Center in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.