Shannon Rene Wallin, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

41717 Palm Ave
Fremont, CA 94539-4722

Phone

(510) 657-3600

NPI assigned

Aug 29, 2023

Last updated

Aug 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shannon Rene Harms Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• City of Fremont

  dba Mission San Jose High

  • Community/Behavioral Health Agency
  • Fremont, CA
  • NPI 1801277223
  NPD

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

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1649055476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41717 PALM AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945394722",
            "telephone_number": "510-657-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIN",
        "first_name": "SHANNON",
        "middle_name": "RENE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-29",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "HARMS",
            "middle_name": "RENE",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Scott Walker, D.C.
• Ekua Nayena Taylor Walker, RN, MS, NP
• Isabell Walker
• Neeva Patel Walker, MPT
• Todd Christopher Walker, PT
• Walmart Inc. (Walmart Pharmacy 10-2989)
• Walter Y. Kitajima, D.D.S., Inc.
• Monique Walton
• Michael P. Walvick, DO
• Agnes Wang

• Athletic Trainer in Fremont, CA
• Providers in Fremont, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.