Active NPI
Shawn Allen Shianna, MD
- Otolaryngology Physician
- Freeport, IL
National Provider Identifier
1609083336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 036078475
- Practice address
- 1030 S Kunkle Blvd
Freeport, IL 61032-6914 - Phone
- (815) 599-7850
- Fax
- (815) 235-1310
- NPI assigned
- May 16, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 036078475 | IL | Primary |
Addresses
Primary practice location
1030 S Kunkle Blvd
Freeport, IL 61032-6914
Mailing address
1030 S Kunkle Blvd
Freeport, IL 61032-6914
Phone (815) 599-7850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036078475 | Medicaid | IL |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266883200000",
"number": "1609083336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1030 S KUNKLE BLVD",
"city": "FREEPORT",
"state": "IL",
"postal_code": "610326914",
"telephone_number": "815-599-7850",
"fax_number": "815-235-1310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 S KUNKLE BLVD",
"city": "FREEPORT",
"state": "IL",
"postal_code": "610326914",
"telephone_number": "815-599-7850",
"fax_number": "815-235-1310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIANNA",
"first_name": "SHAWN",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-16",
"last_updated": "2010-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "IL",
"license": "036078475",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036078475",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Freeport, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.