Shannon Poplstein Mayberry, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-03634 Issued in NC

Practice address

3711 University Dr
Durham, NC 27707-2654

Phone

(919) 752-4028

NPI assigned

Jul 9, 2012

Last updated

Oct 14, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.poplstein.1@12529.direct.athenahealth.com
• Direct secure messaging: shannon.poplstein.1@2104.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1770848400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 PEGRAM CT",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277037970",
            "telephone_number": "540-761-8091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3711 UNIVERSITY DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072654",
            "telephone_number": "919-752-4028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3528 Davis Dr",
            "address_purpose": "LOCATION",
            "city": "Morrisville",
            "state": "NC",
            "postal_code": "275608819",
            "country_code": "US",
            "telephone_number": "919-234-6016",
            "fax_number": "919-650-2647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "SHANNON",
        "middle_name": "POPLSTEIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-09",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grady May
• Jim May
• Rebecca May
• Shanna Leigh May, LCSW
• Jordan L. Mayberry, MD
• Angela Lee Mayes, LCSW
• Katherine L'Amour Mayfour
• Eric Douglas Mayhew, MS, LPC
• Cicely Maynard, ,QP, MA LPC-A
• Jordan Alan Maynard, DNP, CRNA

• Physician Assistant in Durham, NC
• Providers in Durham, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; 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.