Individual provider Active NPI

Shannon Nicole Roberts, STNA, PCT, MT

  • Personal Care Attendant
  • Columbus, OH
National Provider Identifier
1629286869
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Personal Care AttendantTaxonomy code 3747P1801X
Practice address
1813 Flinthill Dr
Columbus, OH 43223-3542
Phone
(614) 305-3569
NPI assigned
May 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse's Aide 376K00000X 320578730298 OH
Personal Care Attendant 3747P1801X OH Primary

Addresses

Primary practice location

1813 Flinthill Dr
Columbus, OH 43223-3542

Mailing address

1813 Flinthill Dr
Columbus, OH 43223-3542
Phone (614) 305-3569

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)
Not enrolled
Credentials
Medical Technician

State licenses

LicenseStateTypeSpecialty
320578730298OHMDNurse's Aide

NPI Registry JSON

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

{
    "created_epoch": "1179619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1629286869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 FLINTHILL DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432233542",
            "telephone_number": "614-305-3569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 FLINTHILL DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432233542",
            "telephone_number": "614-305-3569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "SHANNON",
        "middle_name": "NICOLE",
        "credential": "STNA, PCT, MT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-20",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "OH",
            "license": "320578730298",
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.