Active NPI
Banisha Monay Evans, CPT LL
- Phlebology Physician
- Elk Grove, CA
National Provider Identifier
1780342675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebology Physician
- License
- CPA02209141
- Practice address
- 8674 Nemea Way
Elk Grove, CA 95624-3444 - Phone
- (510) 859-6555
- NPI assigned
- Dec 7, 2021
- 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 |
|---|---|---|---|---|
| Phlebology Physician | 202K00000X | CPA02209141 | CA | Primary |
Addresses
Primary practice location
8674 Nemea Way
Elk Grove, CA 95624-3444
Mailing address
8674 Nemea Way
Elk Grove, CA 95624-3444
Phone (510) 859-6555
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 |
|---|---|---|---|
| CPA02209141 | CA | MD | Phlebology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638835200000",
"number": "1780342675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8674 NEMEA WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956243444",
"telephone_number": "510-859-6555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8674 NEMEA WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956243444",
"telephone_number": "510-859-6555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "BANISHA",
"middle_name": "MONAY",
"credential": "CPT LL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-07",
"last_updated": "2021-12-07",
"certification_date": "2021-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "202K00000X",
"taxonomy_group": "",
"desc": "Phlebology",
"state": "CA",
"license": "CPA02209141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.