Shannel Anyae Pegram, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

183218 Issued in NC

Practice address

1100 Wilford Hall Loop # 4554
Jbsa Lackland, TX 78236-5638

Phone

(210) 292-6255

Fax

(210) 292-7934

NPI assigned

Jun 7, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1710248653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP # 4554",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-292-6255",
            "fax_number": "210-292-7934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP # 4554",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-292-6255",
            "fax_number": "210-292-7934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEGRAM",
        "first_name": "SHANNEL",
        "middle_name": "ANYAE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-07",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NC",
            "license": "183218",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "183218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allan S Parke, DDS
• Michael Ryan Parks, D.O.
• Eric R Parsons, PHARM. D.
• Martha Ellan Paul, CRNA
• Mary T Pawlak, MD
• Daniel Alexander Perales, PHYSICIAN ASSISTANT
• Ismael Perez
• Mack Andelin Peterson, D.O.
• Kyle Petrey, DPT
• Jamila Lee Petterson, PAC

• Family Medicine Physician in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.