Active NPI
Shiny Jacob
- Psychiatric/Mental Health Nurse Practitioner
- Redlands, CA
National Provider Identifier
1700638293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 95028911
- Practice address
- 1030 Nevada St
Redlands, CA 92374-2957 - Phone
- (909) 553-0055
- NPI assigned
- Apr 5, 2024
- 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 |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95028911 | CA | Primary |
Addresses
Primary practice location
1030 Nevada St
Redlands, CA 92374-2957
Mailing address
5360 Corison Way
Fontana, CA 92336-5995
Phone (909) 553-0055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2131 Elks Dr
Suite 104
San Bernardino, CA 92404-5571
Phone (909) 966-5500
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David Desai MD Inc | Single Specialty | Current | Accepting new patients |
Locations
2131 Elks Dr
Ste 104
Sn Bernrdno, CA 92404
Phone (909) 966-5500
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- San Jose, CA
- NPI 1154994846
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781136000000",
"number": "1700638293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5360 CORISON WAY",
"city": "FONTANA",
"state": "CA",
"postal_code": "923365995",
"telephone_number": "909-553-0055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 NEVADA ST",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923742957",
"telephone_number": "909-553-0055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "SHINY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-05",
"last_updated": "2026-06-11",
"certification_date": "2026-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CA",
"license": "95028911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.