Active NPI
Shannon Joy Dehesa, O.D,
- Pediatric Optometrist
- Davie, FL
National Provider Identifier
1477783652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Optometrist
- License
- 13755
- Practice address
- 3200 S University Dr
Davie, FL 33328-2018 - Phone
- (617) 314-3845
- NPI assigned
- Jul 21, 2009
- Last updated
- Nov 30, 2010
- 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 |
|---|---|---|---|---|
| Pediatric Optometrist | 152WP0200X | 13755 | CA | Primary |
Addresses
Primary practice location
3200 S University Dr
Davie, FL 33328-2018
Mailing address
28108 Twin Ponds Rd
Clovis, CA 93619-9656
Phone (617) 314-3845
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13755 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291075200000",
"number": "1477783652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28108 TWIN PONDS RD",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936199656",
"telephone_number": "617-314-3845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 S UNIVERSITY DR",
"city": "DAVIE",
"state": "FL",
"postal_code": "333282018",
"telephone_number": "617-314-3845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEHESA",
"first_name": "SHANNON",
"middle_name": "JOY",
"name_prefix": "Mrs.",
"credential": "O.D,",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-21",
"last_updated": "2010-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "CA",
"license": "13755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.