Shannan Kelly Sanborn, QMHA

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

20370 Poe Sholes Dr
Bend, OR 97703-7938

Phone

(541) 318-1377

Fax

(541) 383-4587

NPI assigned

Feb 21, 2017

Last updated

Feb 21, 2017By 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

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1932648144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20370 POE SHOLES DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037938",
            "telephone_number": "541-318-1377",
            "fax_number": "541-383-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20370 POE SHOLES DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037938",
            "telephone_number": "541-318-1377",
            "fax_number": "541-383-4587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANBORN",
        "first_name": "SHANNAN",
        "middle_name": "KELLY",
        "credential": "QMHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-21",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sampson Physical Therapy, Inc (Southside Physical Therapy, Inc)
• Jonathan P Sampson, PT
• Mark E Sampson, MD
• Morag Helen, Shaw Sampson, P.T.
• Kallie Michelle Sanborn
• Ana Ofelia Sanchez
• Anissa Sanchez
• David A Sanchez
• Elizabeth Sanchez
• Regina Sanchez, CHW

• Behavior Technician in Bend, OR
• Providers in Bend, OR by specialty
• Behavior Technician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; 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.