Shaundelle Ann Olusanya, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2003014072 Issued in MO

Practice address

1060 S Bishop Ave
Rolla, MO 65401-4411

Phone

(573) 426-5900

Fax

(573) 426-4466

NPI assigned

Jun 14, 2007

Last updated

Apr 15, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• South Central Missouri Community Health Center

  dba Four Rivers Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Rolla, MO
  • NPI 1164669172
  Medicare reassignment NPD
• South Central Missouri Community Health Center

  dba Four Rivers Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Salem, MO
  • NPI 1194615757
  NPD

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460678400000",
    "number": "1801090444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 S BISHOP AVE",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014411",
            "telephone_number": "573-426-5900",
            "fax_number": "573-426-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 S BISHOP AVE",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014411",
            "telephone_number": "573-426-5900",
            "fax_number": "573-426-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUSANYA",
        "first_name": "SHAUNDELLE",
        "middle_name": "ANN",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2016-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2003014072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashante Novy-Pritchard
• Chimnoya N Nwagwu-Youlo, MD
• Daniel O'Loughlin, D.O.
• Sarah Eileen Oerther, FNP-BC, RN
• Oluyomi O Olusanya, MD
• Melissa Selene Olvera, DDS
• Brittany Nicole Opsomer, RN
• Ifeanyi Samuel Orizu Sr., MD
• Jennie Lyn Orlando, MSN, APRN, FNP
• Osage Bone and Joint Clinic, Inc

• Family Nurse Practitioner in Rolla, MO
• Providers in Rolla, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; 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.