Debra Joan Shanley

Primary specialty

Mastectomy FitterTaxonomy code 224900000X

License

C52324 Issued in CA

Practice address

2500 Mowry Ave Ste 130
Fremont, CA 94538-1605

Phone

(510) 790-1911

Fax

(510) 505-1960

NPI assigned

Feb 20, 2024

Last updated

Feb 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1708387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1922863794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 MOWRY AVE STE 130",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381605",
            "telephone_number": "510-790-1911",
            "fax_number": "510-505-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 MOWRY AVE STE 130",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381605",
            "telephone_number": "510-790-1911",
            "fax_number": "510-505-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANLEY",
        "first_name": "DEBRA",
        "middle_name": "JOAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224900000X",
            "taxonomy_group": "",
            "desc": "Mastectomy Fitter",
            "state": "CA",
            "license": "C52324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mastectomy Fitter in Fremont, CA
• Providers in Fremont, CA by specialty
• Mastectomy Fitter in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; 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.