Active NPI
Shonie Dannette Shanes, L.M.P.
- Massage Therapist
- Clearlake, WA
National Provider Identifier
1497965925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00010617
- Practice address
- 12263 North Mill Street
Clearlake, WA 98235 - Phone
- (360) 856-5354
- NPI assigned
- May 23, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | MA00010617 | WA | Primary |
Addresses
Primary practice location
12263 North Mill Street
Clearlake, WA 98235
Mailing address
24397 E State St
Sedro Woolley, WA 98284-8308
Phone (360) 856-1992
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 115508 | Other | WA | LABOR AND INDUSTRIES |
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 |
|---|---|---|---|
| MA00010617 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497965925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24397 E STATE ST",
"city": "SEDRO WOOLLEY",
"state": "WA",
"postal_code": "982848308",
"telephone_number": "360-856-1992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12263 NORTH MILL STREET",
"city": "CLEARLAKE",
"state": "WA",
"postal_code": "98235",
"telephone_number": "360-856-5354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANES",
"first_name": "SHONIE",
"middle_name": "DANNETTE",
"name_prefix": "Mrs.",
"credential": "L.M.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00010617",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRIES",
"identifier": "115508",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clearlake, WA
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.