Active NPI
Shannon Roberts, PTA
- Specialist
- Spartanburg, SC
National Provider Identifier
1467817072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1346
- Practice address
- 175 Burdette St
Spartanburg, SC 29307-1003 - Phone
- (864) 596-8491
- NPI assigned
- Dec 24, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 1346 | SC | Primary |
Addresses
Primary practice location
175 Burdette St
Spartanburg, SC 29307-1003
Mailing address
1271 Bethesda Rd
Spartanburg, SC 29302-5710
Phone (864) 590-1542
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 |
|---|---|---|---|
| 1346 | SC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450915200000",
"number": "1467817072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1271 BETHESDA RD",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293025710",
"telephone_number": "864-590-1542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 BURDETTE ST",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293071003",
"telephone_number": "864-596-8491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "SHANNON",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-24",
"last_updated": "2015-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "SC",
"license": "1346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spartanburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.