Ebony Shardae Helaire

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

106815 Issued in CA

Practice address

415 Georgia St
Vallejo, CA 94590-6004

Phone

(707) 558-2000

NPI assigned

Mar 23, 2020

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

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1346262292
  NPD (past)
• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Pittsburg, CA
  • NPI 1528080470
  NPD (past)

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1932736774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 MOKELUMNE DR",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945319057",
            "telephone_number": "510-755-6824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 GEORGIA ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945906004",
            "telephone_number": "707-558-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HELAIRE",
        "first_name": "EBONY",
        "middle_name": "SHARDAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-23",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "106815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Hebert, LCSW
• Catherine Ann Heckert, NPF
• Shefali Hegde, MD
• Kasaundra Rae Heiberger, PA-C, MPH
• Jasmine Heinemann
• Helios Healthcare, LLC
• Amanda Jane Helle, DO
• Jessica Henderson
• Kelby Unique Henderson
• Kristen Henderson, OTR/L

• All providers in Vallejo, CA
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.