Active NPI
Shawna Dorene Avery, OTC
- Other Technician
- Modesto, CA
National Provider Identifier
1477613883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 1409 E Briggsmore Ave
Modesto, CA 95355-2707 - Phone
- (209) 521-6097
- Fax
- (209) 572-4579
- NPI assigned
- Dec 8, 2006
- 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 |
|---|---|---|---|---|
| Other Technician | 247200000X | Primary |
Addresses
Primary practice location
1409 E Briggsmore Ave
Modesto, CA 95355-2707
Mailing address
1409 E Briggsmore Ave
Modesto, CA 95355-2707
Phone (209) 521-6097
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": "1165536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477613883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1409 E BRIGGSMORE AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953552707",
"telephone_number": "209-521-6097",
"fax_number": "209-572-4579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1409 E BRIGGSMORE AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953552707",
"telephone_number": "209-521-6097",
"fax_number": "209-572-4579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVERY",
"first_name": "SHAWNA",
"middle_name": "DORENE",
"name_prefix": "Mr.",
"credential": "OTC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.