Shaquanda Shantivus Gordon, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN269437 Issued in GA

Practice address

825 Belmar Pass
Fairburn, GA 30213-4482

Phone

(229) 603-2601

NPI assigned

Jul 19, 2023

Last updated

Oct 12, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brave Health Medical Group, PAGroup PAC ID 9537586052, 93 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Brave Health Medical Group PA

  • Community/Behavioral Health Agency
  • Miami, FL
  • NPI 1225669161

  GA

  Medicare reassignment Care Compare group NPD
• Inner Community Health

  • Psychiatry Physician
  • Duluth, GA
  • NPI 1891398541
  Medicare reassignment NPD

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

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791763200000",
    "number": "1891475430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 BELMAR PASS",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134482",
            "telephone_number": "229-603-2601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 BELMAR PASS",
            "city": "FAIRBURN",
            "state": "GA",
            "postal_code": "302134482",
            "telephone_number": "229-603-2601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Highlands Pkwy SE Ste 400",
            "address_purpose": "LOCATION",
            "city": "Smyrna",
            "state": "GA",
            "postal_code": "300825192",
            "country_code": "US",
            "telephone_number": "888-588-8995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "SHAQUANDA",
        "middle_name": "SHANTIVUS",
        "name_prefix": "Miss",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-19",
        "last_updated": "2026-10-12",
        "certification_date": "2026-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "APRN269437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tommika George
• Georgia CVS Pharmacy, L.L.C. (CVS Pharmacy #04709)
• Chandra E. Giles, CCC-SLP
• Golden Living Healthcare Services, LLC
• Golden Path Senior Services, LLC
• Paul Everett Graham
• Jasmine Grant, LAPC
• Christen L Green
• La'Doria Richelle Green
• Rona Renell Green, DPM

• Psychiatric/Mental Health Nurse Practitioner in Fairburn, GA
• Providers in Fairburn, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.