Shamika D Wallace, RN, BSN, CWC

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

Practice address

2852 Parkrow LN
San Jose, CA 95132-3537

Phone

(408) 781-7680

NPI assigned

Jun 21, 2021

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

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

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1801465133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2852 PARKROW LN",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951323537",
            "telephone_number": "408-781-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2852 PARKROW LN",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951323537",
            "telephone_number": "408-781-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHAMIKA",
        "middle_name": "D",
        "credential": "RN, BSN, CWC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilbur Gordon Walker Jr., M.D.
• Juliana Wall, OTR/L
• William Walter Wall, M.D.
• Aaron Wallace
• Dameon Wallace
• Tawni Wallace, AU.D.
• Tara-Ann Joy Waller, AU.D.
• Becky L Wallin, MD
• Julie Mae Wallingford, M.ED., BCBA
• Lydia Anna Walls

• Health & Wellness Coach in San Jose, CA
• Providers in San Jose, CA by specialty
• Health & Wellness Coach in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.

Verify at the official NPI Registry.