Active NPI
Dujuan Shakespaere, MS,ATC,LAT
- Athletic Trainer
- St George, UT
National Provider Identifier
1790052058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 7468860-4810
- Practice address
- 652 S Medical Ctr Dr
St George, UT 84790-7017 - Phone
- (435) 251-2286
- NPI assigned
- Nov 30, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 7468860-4810 | UT | Primary |
Addresses
Primary practice location
652 S Medical Ctr Dr
St George, UT 84790-7017
Mailing address
2568 E 160 S
St George, UT 84790-6559
Phone (818) 300-5661
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000002230 | Other | NATIONAL ATHLETIC TRAINERS' ASSOCIATION BOARD OF CERTIFICATION |
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
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7468860-4810 | UT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322611200000",
"number": "1790052058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2568 E 160 S",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847906559",
"telephone_number": "818-300-5661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "652 S MEDICAL CTR DR",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847907017",
"telephone_number": "435-251-2286"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAKESPAERE",
"first_name": "DUJUAN",
"credential": "MS,ATC,LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-30",
"last_updated": "2011-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "UT",
"license": "7468860-4810",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL ATHLETIC TRAINERS' ASSOCIATION BOARD OF CERTIFICATION",
"identifier": "2000002230",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.