Active NPI
Shakera Ann Marie Bucknor Ingram
- Psychologist
- Pembroke Pines, FL
National Provider Identifier
1699323139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 1561 SW 190TH Ave
Pembroke Pines, FL 33029-6148 - Phone
- (305) 332-6572
- NPI assigned
- Aug 28, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
1561 SW 190TH Ave
Pembroke Pines, FL 33029-6148
Mailing address
1561 SW 190TH Ave
Pembroke Pines, FL 33029-6148
Phone (305) 332-6572
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": "1566950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566950400000",
"number": "1699323139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1561 SW 190TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330296148",
"telephone_number": "305-332-6572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1561 SW 190TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330296148",
"telephone_number": "305-332-6572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKNOR INGRAM",
"first_name": "SHAKERA",
"middle_name": "ANN MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-28",
"last_updated": "2019-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.