Shane Fitness LLC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Legal business name

SHANE FITNESS LLC

Practice address

1122 Walnut St
Ypsilanti, MI 48198-3937

Phone

(734) 320-4819

NPI assigned

Sep 10, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Deland Maurice McMullan Jr., ATHLETIC TRAINERNPI 1295345056

Title

Athletic Training

Phone

(734) 320-4819

Specialties & licenses 1

Addresses

Other names 1

• Shane Fitness 101 Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deland Maurice McMullan Jr.

  • Athletic Trainer
  • Ypsilanti, MI
  • NPI 1295345056
  NPD Authorized official

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

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599696000000",
    "number": "1871108563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 WALNUT ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481983937",
            "telephone_number": "734-320-4819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 WALNUT ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481983937",
            "telephone_number": "734-320-4819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE FITNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-10",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A",
        "authorized_official_last_name": "MCMULLAN",
        "authorized_official_first_name": "DELAND",
        "authorized_official_middle_name": "MAURICE",
        "authorized_official_title_or_position": "ATHLETIC TRAINING",
        "authorized_official_telephone_number": "734-320-4819",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "ATHLETIC TRAINER"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@shanefitness101.com",
            "affiliation": "N",
            "endpointDescription": "info@shanefitness101.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1122 Walnut St",
            "city": "Ypsilanti",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481983937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Shane Fitness 101",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Haneen Shalash, MSW
• Alexander Shalhoub, D.O.
• Marina Shamoon
• Sophia Shampine
• Janet M Shanahan, NP
• Tara Shankar, MD
• Beth-Ann Shanker, MD
• R. Timothy Shannon, LLPC
• Lori Shapiro
• Paul Shapiro, M.D.

• Athletic Trainer in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.