Active NPI
Shane David
- Marriage & Family Therapist
- Oakland, CA
National Provider Identifier
1629326418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 82036
- Practice address
- 490 Lake Park Ave Unit 10524
Oakland, CA 94610-8018 - Phone
- (510) 473-8806
- NPI assigned
- Aug 27, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 82036 | CA | Primary |
Addresses
Primary practice location
490 Lake Park Ave Unit 10524
Oakland, CA 94610-8018
Mailing address
490 Lake Park Ave Unit 10524
Oakland, CA 94610-8018
Phone (510) 473-8806
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82036 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427068800000",
"number": "1629326418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "490 LAKE PARK AVE UNIT 10524",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946108018",
"telephone_number": "510-473-8806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "490 LAKE PARK AVE UNIT 10524",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946108018",
"telephone_number": "510-473-8806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVID",
"first_name": "SHANE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-08-27",
"last_updated": "2015-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "82036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.