Shannon Monique Medina

Primary specialty

Social WorkerTaxonomy code 104100000X

License

X-11248 Issued in NM

Practice address

13 Old School Rd
Penasco, NM 87553

Phone

(575) 587-2502

NPI assigned

Sep 18, 2019

Last updated

Sep 18, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568764800000",
    "number": "1366092645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "city": "PENASCO",
            "state": "NM",
            "postal_code": "875530520",
            "telephone_number": "575-587-2502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 OLD SCHOOL RD",
            "city": "PENASCO",
            "state": "NM",
            "postal_code": "87553",
            "telephone_number": "575-587-2502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "SHANNON",
        "middle_name": "MONIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-18",
        "last_updated": "2019-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "NM",
            "license": "376369",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "X-11248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David N Gould, PA-C
• Carrrian Marie Hamilton
• Michelle Hamilton
• Lizabeth L. Jamison, RDH
• Mas Comunidad
• Rachel Moore, RDH
• Douglas A. North, PA-C
• Mia G Pacheco, LMSW
• Penasco Independent Schools
• Picuris Medical Center

• Social Worker in Penasco, NM
• Providers in Penasco, NM by specialty
• Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; 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.