Active NPI
Andrew Shonk
- Massage Therapist
- Portland, OR
National Provider Identifier
1487178711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 21837
- Practice address
- 163 NE 102ND Ave Blid V
Portland, OR 97220 - Phone
- (503) 257-3327
- Fax
- (503) 257-3374
- NPI assigned
- Jul 28, 2017
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 21837 | OR | Primary |
Addresses
Primary practice location
163 NE 102ND Ave Blid V
Portland, OR 97220
Mailing address
163 NE 102ND Ave # Blidv
Portland, OR 97220-4169
Phone (503) 257-3327
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 |
|---|---|---|---|
| 21837 | OR | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1487178711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 NE 102ND AVE # BLIDV",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972204169",
"telephone_number": "503-257-3327",
"fax_number": "503-257-3374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 NE 102ND AVE BLID V",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97220",
"telephone_number": "503-257-3327",
"fax_number": "503-257-3374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHONK",
"first_name": "ANDREW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-28",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "21837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.