Active NPI
Shannon Domfort
- Pediatric Occupational Therapist
- St Petersburg, FL
National Provider Identifier
1376912063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- OT20621
- Practice address
- 4200 4TH St N Ste B
Saint Petersburg, FL 33703-4735 - Phone
- (727) 592-5417
- NPI assigned
- Sep 23, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT20621 | FL | Primary |
Addresses
Primary practice location
4200 4TH St N Ste B
Saint Petersburg, FL 33703-4735
Mailing address
4200 4TH St N Ste B
Saint Petersburg, FL 33703-4735
Phone (727) 592-5417
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT20621 | FL | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782086400000",
"number": "1376912063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 4TH ST N STE B",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337034735",
"telephone_number": "727-592-5417"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 4TH ST N STE B",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337034735",
"telephone_number": "727-592-5417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMFORT",
"first_name": "SHANNON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-23",
"last_updated": "2026-06-22",
"certification_date": "2026-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "FL",
"license": "OT20621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.