Shannon Petersen

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

234500 Issued in FL

Practice address

7983 NW 35TH CT
Coral Springs, FL 33065-3015

Phone

(954) 630-6879

NPI assigned

Sep 1, 2016

Last updated

Sep 1, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1376099077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7983 NW 35TH CT",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330653015",
            "telephone_number": "954-630-6879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7983 NW 35TH CT",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330653015",
            "telephone_number": "954-630-6879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "SHANNON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "FL",
            "license": "234500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elsa Pestana, MD
• Ivo D Pestana, MD
• Tatiana Angelica Pestana, MD, MPH
• Ronell Thomas Peters, OTR
• Molly Jo Petersen, PTA
• Kylie Petrovich
• Raymond Phenow
• Philip F Averbuch MD PA
• Farah Philippe, APRN
• Richard Gary Philips, DPM

• Case Manager/Care Coordinator in Coral Springs, FL
• Providers in Coral Springs, FL by specialty
• Case Manager/Care Coordinator in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.