Individual provider Active NPI

Shadrin K Constance

  • Family Nurse Practitioner
  • Excelsior, MN
National Provider Identifier
1609632223
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
12211 Issued in MN
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, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250324000400 MN Practitioner - Nurse Practitioner 1951823657 Reassigns benefits to 3 organizations

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
Rehabilitation Medicine Associates LLCGroup PAC ID 9335465558, 10 clinicians

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

LicenseStateTypeSpecialty
238554-5MNMDRegistered Nurse
12211MNMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rehabilitation Medicine Associates, LLC CurrentSince May 5, 2025 Accepting new patients
Applebaum Physiatry PLLC Family CurrentSince Dec 17, 2024 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.

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

Verify at the official NPI Registry.