Shodetta Remilekun Bun-Mansaray, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN267458 Issued in GA

Practice address

2720 Loganville Hwy
Loganville, GA 30052-7715

Phone

(866) 389-2727

NPI assigned

Jul 21, 2015

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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 GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Advantage Behavioral Health SystemsGroup PAC ID 1052200599, 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Athens Regional Medical Center Hospital, Athens, GA, CCN 110074

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advantage Behavioral Health Systems

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Athens, GA
  • NPI 1942270558
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Piedmont Athens Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Athens, GA
  • NPI 1437186111
  Care Compare affiliation

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

{
    "created_epoch": "1437436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1942685847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 LOGANVILLE HWY",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527715",
            "telephone_number": "866-389-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 LOGANVILLE HWY",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300527715",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUN-MANSARAY",
        "first_name": "SHODETTA",
        "middle_name": "REMILEKUN",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-21",
        "last_updated": "2022-07-21",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024172278",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN267458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yolanda Brownlee
• Deanna Brubaker, PT
• Chantae Aletha Bryant, PMH-NP
• James Frederick Buck, D.C.
• Jene Denise Bugenhagen, LPC, NCC
• Alisa Joyce Burnett, O.D.
• Garrett M Burr, DPT, PT
• Mary Kate Burrows
• Julie E Burton, SLP
• C&C Care Consultants,LLC

• Family Nurse Practitioner in Loganville, GA
• Providers in Loganville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.