Active NPI
Shade Elizabeth De Jesus
- Behavior Technician
- Ft Lauderdale, FL
National Provider Identifier
1861153447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- D222785895450
- Practice address
- 6750 N Andrews Ave Ste 200
Ft Lauderdale, FL 33309-2180 - Phone
- (954) 758-8748
- NPI assigned
- Jan 5, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | D222785895450 | FL | Primary |
Addresses
Primary practice location
6750 N Andrews Ave Ste 200
Ft Lauderdale, FL 33309-2180
Mailing address
4200 Inverrary Blvd Apt 3807
Lauderhill, FL 33319-4136
Phone (917) 691-6891
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D222785895450 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641340800000",
"number": "1861153447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 INVERRARY BLVD APT 3807",
"city": "LAUDERHILL",
"state": "FL",
"postal_code": "333194136",
"telephone_number": "917-691-6891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6750 N ANDREWS AVE STE 200",
"city": "FT LAUDERDALE",
"state": "FL",
"postal_code": "333092180",
"telephone_number": "954-758-8748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE JESUS",
"first_name": "SHADE",
"middle_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-05",
"last_updated": "2022-01-05",
"certification_date": "2022-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "D222785895450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.