Shani Cacic

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

127355 Issued in FL

Practice address

970 Lake Carillon Dr
St Petersburg, FL 33716-1129

Phone

(813) 503-4594

NPI assigned

Feb 8, 2021

Last updated

Feb 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1612742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1528650884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10703 DOWRY AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336153504",
            "telephone_number": "813-503-4594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "970 LAKE CARILLON DR",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337161129",
            "telephone_number": "813-503-4594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACIC",
        "first_name": "SHANI",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-08",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "FL",
            "license": "127355",
            "primary": true
        },
        {
            "code": "374J00000X",
            "taxonomy_group": "",
            "desc": "Doula",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://form.jotform.com/210324401691141",
            "affiliation": "Y",
            "endpointDescription": "New patient intake form",
            "affiliationName": "Chronos Care Consultants., LLC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Form",
            "address_1": "113 Miles Park Dr",
            "city": "Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "292233289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Surgical Assistant in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Surgical Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.