Shandalee Kimberlee Macedo

Primary specialty

DentistTaxonomy code 122300000X

License

29049 Issued in NY

Practice address

1365 Ohio Ave Apt 304
Long Beach, CA 90804-2450

Phone

(951) 807-8204

NPI assigned

Jan 15, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1705276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705276800000",
    "number": "1659142040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 OHIO AVE APT 304",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908042450",
            "telephone_number": "951-807-8204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 OHIO AVE APT 304",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908042450",
            "telephone_number": "951-807-8204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACEDO",
        "first_name": "SHANDALEE",
        "middle_name": "KIMBERLEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-15",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "29049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "5874",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "568946544",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "securerecords.sanfor.html",
            "affiliation": "Y",
            "affiliationName": "Meharry Medical College, School of Dentistry",
            "address_1": "1007 DB Todd BLvd",
            "address_2": "Meharry Medical College, School of Dentistry 1007DB Tod",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "37208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ricky Phong Tan Mac, MD
• Morgan Macaluso, PH.D.
• Michelle Macaspac
• Mark Anthony Macatrao
• Betty Anne Maccormac, OT
• George A. Macer Jr., M.D.
• Rukhsar Mohamed Karim Machiwalla, PA-C
• Carlos Machuca
• Asia Macias
• Jasmine Macias

• Dentist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; 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.