Active NPI
Shelby Elizabeth Berganciano
- Behavior Technician
- Santa Clara, CA
National Provider Identifier
1659963676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1171 Homestead Rd Ste 250
Santa Clara, CA 95050-5485 - Phone
- (408) 320-2590
- NPI assigned
- Feb 10, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
1171 Homestead Rd Ste 250
Santa Clara, CA 95050-5485
Mailing address
1919 Fruitdale Ave Apt J604
San Jose, CA 95128-4928
Phone (209) 331-6206
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11798071 | Other | CA | KISER PERMANENTE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612915200000",
"number": "1659963676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1919 FRUITDALE AVE APT J604",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951284928",
"telephone_number": "209-331-6206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1171 HOMESTEAD RD STE 250",
"city": "SANTA CLARA",
"state": "CA",
"postal_code": "950505485",
"telephone_number": "408-320-2590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGANCIANO",
"first_name": "SHELBY",
"middle_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-10",
"last_updated": "2021-02-10",
"certification_date": "2021-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KISER PERMANENTE",
"identifier": "11798071",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Clara, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.