Individual provider Active NPI

Chenayi N Shava

  • Foster Care Agency
  • Oakdale, MN
National Provider Identifier
1912667965
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
License
1110802 Issued in MN
Practice address
4864 Heather Ridge Rd N
Oakdale, MN 55128-2228
Phone
(612) 516-1057
NPI assigned
Dec 17, 2021
Last updated
Dec 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foster Care Agency 253J00000X 1110802 MN Primary

Addresses

Primary practice location

4864 Heather Ridge Rd N
Oakdale, MN 55128-2228

Mailing address

4864 Heather Ridge Rd N
Oakdale, MN 55128-2228
Phone (612) 516-1057

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL cnshava2@gmail.com Direct

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

LicenseStateTypeSpecialty
1110802MNMDFoster Care Agency

NPI Registry JSON

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

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1912667965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4864 HEATHER RIDGE RD N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551282228",
            "telephone_number": "612-516-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4864 HEATHER RIDGE RD N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551282228",
            "telephone_number": "612-516-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAVA",
        "first_name": "CHENAYI",
        "middle_name": "N",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-17",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "MN",
            "license": "1110802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "cnshava2@gmail.com",
            "affiliation": "N",
            "endpointDescription": "AFC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4864 Heather Ridge Rd N",
            "city": "Oakdale",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551282228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oakdale, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.