Active NPI
Shanna Nyberg
- Pharmacist
- Phoenix, AZ
National Provider Identifier
1760762959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S016512
- Practice address
- 1334 E Chandler Blvd
Phoenix, AZ 85048-6267 - Phone
- (480) 283-0119
- NPI assigned
- Aug 19, 2011
- Last updated
- Aug 19, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S016512 | AZ | Primary |
| Pharmacist | 183500000X | PH00015824 | WA |
Addresses
Primary practice location
1334 E Chandler Blvd
Phoenix, AZ 85048-6267
Mailing address
PO Box 93433
Phoenix, AZ 85070-3433
Phone (425) 221-0024
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S016512 | AZ | MD | Pharmacist |
| PH00015824 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313712000000",
"number": "1760762959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 93433",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850703433",
"telephone_number": "425-221-0024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1334 E CHANDLER BLVD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850486267",
"telephone_number": "480-283-0119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NYBERG",
"first_name": "SHANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-19",
"last_updated": "2011-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S016512",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00015824",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.