Stephanie De Shano Wakeman, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

35468 Issued in FL

Practice address

13791 Saxon Lake Dr
Jacksonville, FL 32225-2624

Phone

(609) 306-9729

NPI assigned

Apr 16, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Celloscope Inc

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1356917934
  NPD
• Ipta Clinical, LLC

  • Physical Therapy Clinic/Center
  • Medford, NJ
  • NPI 1760764484

  Physical Therapist

  NPD

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1487879532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13791 SAXON LAKE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322252624",
            "telephone_number": "606-306-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13791 SAXON LAKE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322252624",
            "telephone_number": "609-306-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE SHANO WAKEMAN",
        "first_name": "STEPHANIE",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2021-06-07",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "10037",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "27835",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01013200",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "35468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• De Padua and de Padua MD PA
• Virgilio De Padua II, MD
• Lisa A. De Palma, P.T.
• Camila De Prado Campos Ferreira
• Maria De Rosado
• Hernando De Soto, M.D.
• Bruno De Souza Ribeiro
• Katherine Ashley De Souza, DNP, APRN
• De Urgent Care Jax PA
• De2 LLC

• Physical Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.