Active NPI
Shauna Marie Clevelle, RN
- General Practice Registered Nurse
- Fairborn, OH
National Provider Identifier
1730437377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- RN 382765
- Practice address
- 209 N Huron CT
Fairborn, OH 45324-2775 - Phone
- (937) 430-6900
- NPI assigned
- Aug 28, 2012
- 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 |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | RN 382765 | OH | Primary |
Addresses
Primary practice location
209 N Huron CT
Fairborn, OH 45324-2775
Mailing address
209 N Huron CT
Fairborn, OH 45324-2775
Phone (937) 430-6900
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0073636 | Other | OH | ODJFS MEDICAID PROVIDER NUMBER |
| 2903415 | Other | OH | OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES CONTRACT NUMBER |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN 382765 | OH | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353456000000",
"number": "1730437377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 N HURON CT",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453242775",
"telephone_number": "937-430-6900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 N HURON CT",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453242775",
"telephone_number": "937-430-6900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEVELLE",
"first_name": "SHAUNA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-28",
"last_updated": "2012-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "OH",
"license": "RN 382765",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ODJFS MEDICAID PROVIDER NUMBER",
"identifier": "0073636",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES CONTRACT NUMBER",
"identifier": "2903415",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.