Active NPI
Shana-Kay Shantell Rose
- Behavior Technician
- Shakopee, MN
National Provider Identifier
1922608256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 4201 Dean Lakes Blvd Ste 160
Shakopee, MN 55379-2863 - Phone
- (612) 509-6691
- NPI assigned
- Oct 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
4201 Dean Lakes Blvd Ste 160
Shakopee, MN 55379-2863
Mailing address
8660 Old Cedar Ave S Apt 211
Bloomington, MN 55425-2028
Phone (754) 332-6318
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588993091 | Medicaid | MN |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1922608256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8660 OLD CEDAR AVE S APT 211",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554252028",
"telephone_number": "754-332-6318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 DEAN LAKES BLVD STE 160",
"city": "SHAKOPEE",
"state": "MN",
"postal_code": "553792863",
"telephone_number": "612-509-6691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "SHANA-KAY",
"middle_name": "SHANTELL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-27",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1588993091",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shakopee, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.