Active NPI
Shawn Kristopher Petrucci
- Athletic Trainer
- Wakefield, RI
National Provider Identifier
1689178154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 153 Kings Ridge Rd
Wakefield, RI 02879-7675 - Phone
- (401) 575-7122
- NPI assigned
- Mar 20, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
153 Kings Ridge Rd
Wakefield, RI 02879-7675
Mailing address
153 Kings Ridge Rd
Wakefield, RI 02879-7675
Phone (401) 575-7122
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": "1521504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521504000000",
"number": "1689178154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "153 KINGS RIDGE RD",
"city": "WAKEFIELD",
"state": "RI",
"postal_code": "028797675",
"telephone_number": "401-575-7122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "153 KINGS RIDGE RD",
"city": "WAKEFIELD",
"state": "RI",
"postal_code": "028797675",
"telephone_number": "401-575-7122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUCCI",
"first_name": "SHAWN",
"middle_name": "KRISTOPHER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-20",
"last_updated": "2018-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wakefield, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.