Active NPI
Ayantu Kayo Shankulie
- Behavior Technician
- Richfield, MN
National Provider Identifier
1508612938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1001 E 77TH St Apt 305
Richfield, MN 55423-4551 - Phone
- (651) 421-5221
- NPI assigned
- Apr 26, 2024
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
1001 E 77TH St Apt 305
Richfield, MN 55423-4551
Mailing address
111 Kellogg Blvd E Apt 1514
Saint Paul, MN 55101-1214
Phone (651) 421-5221
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714089600000",
"number": "1508612938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 KELLOGG BLVD E APT 1514",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551011214",
"telephone_number": "651-421-5221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 E 77TH ST APT 305",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554234551",
"telephone_number": "651-421-5221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANKULIE",
"first_name": "AYANTU",
"middle_name": "KAYO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-26",
"last_updated": "2024-04-26",
"certification_date": "2023-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.