Shujen T Fernandez, ARNP-C, CCRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN9167756 Issued in FL

Practice address

10920 Moss Park Rd Ste 200
Orlando, FL 32832-6087

Phone

(407) 846-0533

Fax

(407) 518-1730

NPI assigned

Nov 21, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in FL

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mindful Behavioral Healthcare LLCGroup PAC ID 7810162740, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shujen.fernandez.1@22714.direct.athenahealth.com
• Direct secure messaging: shujen.fernandez@087.emedpractice.direct-ci.com

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

• Mindful Behavioral Healthcare, LLC

  • Community/Behavioral Health Agency
  • Kissimmee, FL
  • NPI 1477744548
  Medicare reassignment Care Compare group NPD
• Nova Psychiatry Inc

  • Psychiatry Physician
  • Orlando, FL
  • NPI 1285075739
  Medicare reassignment NPD
• Mindful Integrated Medicine LLC

  • General Practice Physician
  • Kissimmee, FL
  • NPI 1831544832
  NPD (past)

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

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1912304759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2316 HILLCREST ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328034900",
            "telephone_number": "407-228-2804",
            "fax_number": "407-228-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10920 MOSS PARK RD STE 200",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328326087",
            "telephone_number": "407-846-0533",
            "fax_number": "407-518-1730"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2316 Hillcrest St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328034900",
            "country_code": "US",
            "telephone_number": "407-228-2804",
            "fax_number": "407-228-2806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "SHUJEN",
        "middle_name": "T",
        "credential": "ARNP-C, CCRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-21",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9167756",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN9167756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "OB747",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC",
            "identifier": "2018014428",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ACADEMY OF NURSE PRACTITIONERS",
            "identifier": "F0914948",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN NO",
            "identifier": "IA275X",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marlene Fernandez, DO
• Mary Mae B Fernandez, PT
• Miguel Jacobo Fernandez, MD
• Mildred Milagros Fernandez, MA FL-CBA
• Paulette Fernandez, APRN
• Tiffany Fernandez
• Fernando L Gomez MD PA
• Ferncreek Healing Center, LLC
• Marina De Oliveira Ferracciu, BT
• Cal Ferrante, CRNA

• Psychiatric/Mental Health Nurse Practitioner in Orlando, FL
• Providers in Orlando, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.