Shelletta Baker

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Practice address

303 N Laura St
Jacksonville, FL 32202

Phone

(904) 321-9360

NPI assigned

Aug 21, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 12

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Mymathmentors, LLC.

  • Local Education Agency (LEA)
  • Jacksonville, FL
  • NPI 1992264337
  NPD (past) Authorized official

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

{
    "created_epoch": "1534809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1801376629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40201",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322030201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N LAURA ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32202",
            "telephone_number": "904-321-9360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10599 Deerwood Park Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322560507",
            "country_code": "US",
            "telephone_number": "904-321-9360",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3435 University Blvd N",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322772464",
            "country_code": "US",
            "telephone_number": "904-321-9360",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2875 Park St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322058046",
            "country_code": "US",
            "telephone_number": "904-321-9360",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12125 San Jose Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322232636",
            "country_code": "US",
            "telephone_number": "904-321-9360",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1826 Dunn Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322184712",
            "country_code": "US",
            "telephone_number": "904-321-9360",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1755 Edgewood Ave W",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322083224",
            "country_code": "US",
            "telephone_number": "904-321-9360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAKER",
        "first_name": "SHELLETTA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-21",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347E00000X",
            "taxonomy_group": "",
            "desc": "Transportation Broker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374J00000X",
            "taxonomy_group": "",
            "desc": "Doula",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374K00000X",
            "taxonomy_group": "",
            "desc": "Religious Nonmedical Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia J Baker
• Robert Alan Baker, MD
• Sara Baker, QASP
• Scott B Baker, MD
• Shatyron Katese Baker
• Stacy Barczak Baker, ND
• Susan Greene Baker, ARNP-C
• William Garrett Baker, MD
• Rubina Y Bakerywala, M.D.
• Maryam Bakhshandeh, M.D.

• Early Intervention Provider Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Early Intervention Provider Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.