Active NPI
Shaniya Octavia Johnson, LMBT
- Massage Therapist
- Winston Salem, NC
National Provider Identifier
1528834249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 20175
- Practice address
- 2912 Lyndhurst Ave
Winston Salem, NC 27103-4006 - Phone
- (910) 360-3616
- NPI assigned
- Dec 4, 2023
- 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 | 20175 | NC | Primary |
Addresses
Primary practice location
2912 Lyndhurst Ave
Winston Salem, NC 27103-4006
Mailing address
257 Glen Eagles Dr
Winston Salem, NC 27104-5329
Phone (910) 360-3616
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 |
|---|---|---|---|
| 20175 | NC | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701648000000",
"number": "1528834249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "257 GLEN EAGLES DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271045329",
"telephone_number": "910-360-3616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2912 LYNDHURST AVE",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271034006",
"telephone_number": "910-360-3616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "SHANIYA",
"middle_name": "OCTAVIA",
"credential": "LMBT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-04",
"last_updated": "2023-12-04",
"certification_date": "2023-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NC",
"license": "20175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.