Individual provider Active NPI

Shannon Todd, ARNP

  • Pediatric Nurse Practitioner
  • St Petersburg, FL
National Provider Identifier
1578836862
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
ARNP9248104 Issued in FL
Practice address
4278 28TH St N
St Petersburg, FL 33714-3922
Phone
(727) 526-9135
Fax
(727) 526-4346
NPI assigned
Feb 16, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X ARNP9248104 FL Primary

Addresses

Primary practice location

4278 28TH St N
St Petersburg, FL 33714-3922

Mailing address

2701 54TH Ave S
St Petersburg, FL 33712-4777
Phone (727) 867-5788

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

LicenseStateTypeSpecialty
ARNP9248104FLMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mariano D Cibran, MD Corp Dba St Petersburg Pediatrics PastSince Jun 22, 2021 Accepting new patients
Well Health Works Past Accepting new patients
Mariano D Cibran, MD Corp Dba St Petersburg Pediatrics Pediatrics Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1329350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1578836862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 54TH AVE S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337124777",
            "telephone_number": "727-867-5788",
            "fax_number": "727-867-3255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4278 28TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337143922",
            "telephone_number": "727-526-9135",
            "fax_number": "727-526-4346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TODD",
        "first_name": "SHANNON",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-16",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP9248104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; 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.