Shannen Nicole Edwards

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

8350 Archibald Ave Ste 110
Rancho Cucamonga, CA 91730-3670

Phone

(909) 527-3463

NPI assigned

Apr 12, 2024

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1712880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1376397752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8350 ARCHIBALD AVE STE 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303670",
            "telephone_number": "909-527-3463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8350 ARCHIBALD AVE STE 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303670",
            "telephone_number": "909-527-3463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "SHANNEN",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-12",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Behnam Ebrahimi, M.D.
• Econo Drugs
• Fairy Ancheta Edades, P.T.A.
• Geoffrey Dean Edwards, CRNA
• Randi Celeste Edwards
• Terrence Milo Edwards, PSYD
• Robert David Eggleston Jr.
• Ehab Ateia DDS Inc
• Joshua Ehinger, PT, DPT
• Michelle Lynn Ehrle, PHYSICAL THERAPIST

• Community Health Worker in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.