Shanda Nicole Frederick, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

26NP06593200 Issued in NJ

Practice address

633 S 19TH St
1St FL
Newark, NJ 07103-1116

Phone

(862) 576-7768

NPI assigned

Oct 17, 2011

Last updated

Oct 17, 2011By 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 1

Addresses

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": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1538444989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 S 19TH ST",
            "address_2": "1ST FL",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071031116",
            "telephone_number": "862-576-7768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 S 19TH ST",
            "address_2": "1ST FL",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071031116",
            "telephone_number": "862-576-7768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "SHANDA",
        "middle_name": "NICOLE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-17",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NJ",
            "license": "26NP06593200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emerson Franke, M.D.
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• Thomas Michael Friedland, M.D.

• Licensed Practical Nurse in Newark, NJ
• Providers in Newark, NJ by specialty
• Licensed Practical Nurse in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; 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.