Angela Renee Shofner, MD CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3395 Issued in TN

Practice address

300 Stonecrest Blvd
Ste 375
Smyrna, TN 37167

Phone

(615) 220-5796

Fax

(615) 220-8829

NPI assigned

Oct 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Angela Renee Guimbellot Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699863712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 ROCHESTER DR",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "37130",
            "telephone_number": "615-217-7439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 STONECREST BLVD",
            "address_2": "STE 375",
            "city": "SMYRNA",
            "state": "TN",
            "postal_code": "37167",
            "telephone_number": "615-220-5796",
            "fax_number": "615-220-8829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOFNER",
        "first_name": "ANGELA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "MD CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "3395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "GUIMBELLOT",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Smyrna, TN
• Providers in Smyrna, TN by specialty
• Speech-Language Pathologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.