Individual provider Active NPI

Shauna M Brown, AT, LMT, CSCS

  • Athletic Trainer
  • Phoenix, AZ
National Provider Identifier
1629587696
Registry record updated Sep 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
1373 Issued in AZ
Practice address
4221 E Chandler Blvd Ste 116
Phoenix, AZ 85048-8878
Phone
(541) 771-8040
NPI assigned
Sep 21, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 21, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 17519 AZ
Athletic Trainer 2255A2300X 1373 AZ Primary

Addresses

Primary practice location

4221 E Chandler Blvd Ste 116
Phoenix, AZ 85048-8878

Mailing address

4221 E Chandler Blvd Ste 116
Phoenix, AZ 85048-8878
Phone (541) 771-8040

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

LicenseStateTypeSpecialty
1373AZMDOptometrist
17519AZMDMassage Therapist

NPI Registry JSON

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

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505952000000",
    "number": "1629587696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 E CHANDLER BLVD STE 116",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850488878",
            "telephone_number": "541-771-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 E CHANDLER BLVD STE 116",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850488878",
            "telephone_number": "541-771-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "SHAUNA",
        "middle_name": "M",
        "credential": "AT, LMT, CSCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-21",
        "last_updated": "2017-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AZ",
            "license": "17519",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "1373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; 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.