Jennifer Shully, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

101108 Issued in CA

Practice address

2488 Creekside Ave
Napa, CA 94558-4463

Phone

(707) 345-6565

NPI assigned

Jun 19, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, TX2 enrollments

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.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

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.

• C.Funsho Fagbohun,MD,PHD PA

  • Obstetrics & Gynecology Physician
  • Richmond, TX
  • NPI 1932332426
  NPD

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1346654092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2488 CREEKSIDE AVE",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945584463",
            "telephone_number": "707-345-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2488 CREEKSIDE AVE",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945584463",
            "telephone_number": "707-345-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULLY",
        "first_name": "JENNIFER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-19",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "101108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Wade Shifflett, M.D.
• Kirk Shipley
• Joseph Marshall Sholders, M.D.
• Genelle Shomura
• Jennifer Elizabeth Shrum
• Shaelyn Diane Sick
• Fatima Siddique
• Dalia Sierra
• Danielle Sigler
• Jason Silber, CPO

• Clinical Social Worker in Napa, CA
• Providers in Napa, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.

Verify at the official NPI Registry.