Active NPI
Shaelyn Annunziata, PT
- Physical Therapist
- Eden Prairie, MN
National Provider Identifier
1508205865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11769
- Practice address
- 11995 Singletree LN
Eden Prairie, MN 55344-5347 - Phone
- (651) 968-5201
- NPI assigned
- Jun 20, 2013
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11769 | MN | Primary |
Addresses
Primary practice location
11995 Singletree LN
Eden Prairie, MN 55344-5347
Mailing address
4909 Bruce Ave
Edina, MN 55424-1113
Phone (248) 808-8735
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11769 | Other | MN | PT LICENSE |
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 |
|---|---|---|---|
| 40QA01549600 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784764800000",
"number": "1508205865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4909 BRUCE AVE",
"city": "EDINA",
"state": "MN",
"postal_code": "554241113",
"telephone_number": "248-808-8735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11995 SINGLETREE LN",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553445347",
"telephone_number": "651-968-5201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANNUNZIATA",
"first_name": "SHAELYN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-20",
"last_updated": "2026-07-23",
"certification_date": "2026-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11769",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "11769",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.