Active NPI
Shadrin K Constance
- Family Nurse Practitioner
- Excelsior, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 12211
- Practice address
- 464 2ND St Ste 204
Excelsior, MN 55331-2015 - Phone
- (612) 787-8408
- Fax
- (612) 567-8935
- NPI assigned
- Feb 21, 2024
- Last updated
- Jul 17, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 12211 | MN | Primary |
| Registered Nurse | 163W00000X | 238554-5 | MN |
Addresses
Primary practice location
464 2ND St Ste 204
Excelsior, MN 55331-2015
Mailing address
464 2ND St Ste 204
Excelsior, MN 55331-2015
Phone (612) 787-8408
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
464 2ND St
Suite 204
Excelsior, MN 55331-2015
Phone (612) 787-8408
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238554-5 | MN | MD | Registered Nurse |
| 12211 | MN | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabilitation Medicine Associates, LLC | Current | Accepting new patients | |
| Applebaum Physiatry PLLC | Family | Current | Accepting new patients |
Locations
2001 Midwest Rd
Ste 100
Oak Brook, IL 60523
Phone (630) 426-9501
464 2nd St
Ste 204
Excelsior, MN 55331
Phone (612) 787-8404
5123 W 98th St
Minneapolis, MN 55437
Phone (312) 961-4490
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Medicine & Rehabilitation Physician
- Excelsior, MN
- NPI 1093103145
-
- Physical Medicine & Rehabilitation Physician
- Oak Brook, IL
- NPI 1700598059
Family, MN
-
- General Practice Physician
- Delano, MN
- NPI 1205390457
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752710400000",
"number": "1609632223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "464 2ND ST STE 204",
"city": "EXCELSIOR",
"state": "MN",
"postal_code": "553312015",
"telephone_number": "612-787-8408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "464 2ND ST STE 204",
"city": "EXCELSIOR",
"state": "MN",
"postal_code": "553312015",
"telephone_number": "612-787-8408",
"fax_number": "612-567-8935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONSTANCE",
"first_name": "SHADRIN",
"middle_name": "K",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-21",
"last_updated": "2025-07-17",
"certification_date": "2025-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "12211",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "238554-5",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Excelsior, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.