Active NPI
Shana Nicole Pettway
- Behavior Technician
- North Haven, CT
National Provider Identifier
1750920369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 145 Fitch St
North Haven, CT 06473-3706 - Phone
- (203) 239-2564
- NPI assigned
- Dec 30, 2019
- Last updated
- Dec 30, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
145 Fitch St
North Haven, CT 06473-3706
Mailing address
66 Smith St FL 1
Derby, CT 06418-1218
Phone (203) 997-3610
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": "1577664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577664000000",
"number": "1750920369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 SMITH ST FL 1",
"city": "DERBY",
"state": "CT",
"postal_code": "064181218",
"telephone_number": "203-997-3610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 FITCH ST",
"city": "NORTH HAVEN",
"state": "CT",
"postal_code": "064733706",
"telephone_number": "203-239-2564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTWAY",
"first_name": "SHANA",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-30",
"last_updated": "2019-12-30",
"certification_date": "2019-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.