Shantel Azure Fuller

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

400 NE 7TH St
Gresham, OR 97030-5604

Phone

(503) 661-5455

NPI assigned

Mar 24, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Shantel Azure Stone Former name

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": "1206316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206316800000",
    "number": "1629240288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10625 SE 362ND AVE UNIT C8",
            "city": "BORING",
            "state": "OR",
            "postal_code": "970099746",
            "telephone_number": "503-313-6641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NE 7TH ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305604",
            "telephone_number": "503-661-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "SHANTEL",
        "middle_name": "AZURE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANTEL",
            "last_name": "STONE",
            "middle_name": "AZURE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kurt David Fuerstenau, DMD
• Tristan Nadiene Fujita, ATC-R, OTC
• Full Circle Acupuncture
• Bradley Fuller, D.D.S.
• Kimberly Anne Fuller, LMT
• Liana L Funk, PTA
• Lauren Fylan, LAC
• Teri Lyn Gabriel, DC
• Naga Gainor
• Latrece Gaither, M.A.

• Addiction (Substance Use Disorder) Counselor in Gresham, OR
• Providers in Gresham, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; 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.