Wauneka Shunyell Kellum

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1108075 Issued in MN

Practice address

7940 Sierra Pkwy
Brooklyn Park, MN 55444-1955

Phone

(763) 587-3804

NPI assigned

Mar 14, 2021

Last updated

Mar 14, 2021By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1615680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615680000000",
    "number": "1821673518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7940 SIERRA PKWY",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554441955",
            "telephone_number": "763-587-3804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7940 SIERRA PKWY",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554441955",
            "telephone_number": "763-587-3804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLUM",
        "first_name": "WAUNEKA",
        "middle_name": "SHUNYELL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-14",
        "last_updated": "2021-03-14",
        "certification_date": "2021-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "1108075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hebah Fahmi Katabay
• Karvee M Kawalawu, LICSW
• Kayli Residence LLC
• Gary Paul Keifenheim, MSW, LICSW
• Abigail Kelley, MSW, LICSW
• Timothy Anton Kelly
• Chrisanna Kendall
• Jaclyn Mae Kennedy, LMFT
• Sarah Kenzie
• Shawn Kern, LADC

• Community/Behavioral Health Agency in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.