Shakeem Malik Miller

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

814 Emperor Dr
Suisun City, CA 94585-2164

Phone

(707) 366-8589

NPI assigned

May 17, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1621209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1609440403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "814 EMPEROR DR",
            "city": "SUISUN CITY",
            "state": "CA",
            "postal_code": "945852164",
            "telephone_number": "707-366-8589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "814 EMPEROR DR",
            "city": "SUISUN CITY",
            "state": "CA",
            "postal_code": "945852164",
            "telephone_number": "707-366-8589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "SHAKEEM",
        "middle_name": "MALIK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-17",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93650023G68170",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Shakeem@teachacquirethrive.org",
            "affiliation": "N",
            "address_1": "814 Emperor Dr",
            "city": "Suisun City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945852164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carlie Louine Parkinson Madsen, CCC-SLP
• Bryan Mall, M.A., LMFT
• Tatiana M Martin
• Douglas McKoy
• MCN Transportation Service
• Jeremiah Nash
• Latrease Lazette Newman
• Anh-Tu Dinh Nguyen, PHARMD
• Jacqueline Nguyen
• Robert Daniel Nicholas III, CRNA

• Behavior Technician in Suisun City, CA
• Providers in Suisun City, CA by specialty
• Behavior Technician in California

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