Individual provider Active NPI

Shannon Travis Malmquist, PA

  • Medical Physician Assistant
  • Miami, FL
National Provider Identifier
1477736809
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9104405 Issued in FL
Practice address
8900 N. Kendall Dr
Miami Cancer Institute
Miami, FL 33176-2118
Phone
(786) 596-2000
Fax
(305) 279-7778
NPI assigned
Dec 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9104405 FL Primary

Addresses

Primary practice location

8900 N. Kendall Dr
Miami Cancer Institute
Miami, FL 33176-2118

Mailing address

9350 Sunset Dr Ste 200
Miami, FL 33173-3245

Other practice location 1

11750 Bird Rd
Miami, FL 33175-3530
Phone (855) 863-9595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170508002152 FL Practitioner - Physician Assistant 9537446182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palm Beach General Surgery LLCGroup PAC ID 1456455021, 69 clinicians

Practice addresses (Care Compare)

11750 Bird Rd
Miami, FL 33175-3530
Phone (305) 559-1883

11750 SW 40 St
Miami, FL 33175-3530
Phone (305) 854-4400

6705 Sw57Th Ave
Suite 504
South Miami, FL 33143-3644
Phone (305) 669-7332

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Palm Beach General Surgery LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1477736809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9350 SUNSET DR STE 200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331733245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8900 N. KENDALL DR",
            "address_2": "MIAMI CANCER INSTITUTE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331762118",
            "telephone_number": "786-596-2000",
            "fax_number": "305-279-7778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11750 Bird Rd",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331753530",
            "country_code": "US",
            "telephone_number": "855-863-9595",
            "fax_number": "706-868-8375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALMQUIST",
        "first_name": "SHANNON",
        "middle_name": "TRAVIS",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-07",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9104405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.