Active NPI
Shondell Fuller
- Adult Companion
- Fairfield, CA
National Provider Identifier
1417836974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 2261 S Watney Way
Fairfield, CA 94533-6757 - Phone
- (530) 601-0026
- NPI assigned
- Aug 28, 2025
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Adult Companion | 372600000X | Primary |
Addresses
Primary practice location
2261 S Watney Way
Fairfield, CA 94533-6757
Mailing address
PO Box 1011
Davis, CA 95617
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756339200000",
"number": "1417836974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1011",
"city": "DAVIS",
"state": "CA",
"postal_code": "95617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2261 S WATNEY WAY",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336757",
"telephone_number": "530-601-0026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "SHONDELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-28",
"last_updated": "2025-08-28",
"certification_date": "2025-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.