Individual provider Active NPI

Shana Gary, MSW, LCSWA

  • Clinical Social Worker
  • Winston Salem, NC
National Provider Identifier
1649634965
Registry record updated Apr 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P010293 Issued in NC
Practice address
4035 University Pkwy Ste 101
Winston Salem, NC 27106-3275
Phone
(336) 397-1560
NPI assigned
Apr 12, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X P010293 NC Primary

Addresses

Primary practice location

4035 University Pkwy Ste 101
Winston Salem, NC 27106-3275

Mailing address

1625 Olivers Crossing Cir
Winston Salem, NC 27127-7164
Phone (336) 251-5796

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
P010293NCMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1649634965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 OLIVERS CROSSING CIR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271277164",
            "telephone_number": "336-251-5796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 UNIVERSITY PKWY STE 101",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063275",
            "telephone_number": "336-397-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARY",
        "first_name": "SHANA",
        "credential": "MSW, LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-12",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P010293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; 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.