Shanceline Esom Tebo

Primary specialty

PharmacistTaxonomy code 183500000X

License

10860415-1701 Issued in UT

Practice address

60 MDG/MDTS
101 Bodin Circle
Travis Afb, CA 94535-1809

Phone

(707) 423-7657

NPI assigned

May 3, 2024

Sex

Female

Sole proprietor

No

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": "1714694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1962259218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MDG/MDTS",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MDG/MDTS",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-7657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEBO",
        "first_name": "SHANCELINE",
        "middle_name": "ESOM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-03",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "UT",
            "license": "10860415-1701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arlo Modales Tan, M.D.
• Maria Guadalupe Tarin-Lopez, O.D.
• Woody Calvin Taves, D.O.
• Douglas Francis Taylor, D.O.
• Glenhall Elmer Taylor III, M.D.
• The Janz Corporation
• Adrianne Kamara Thompson, M.D.
• Andrew Thompson, IDMT
• Autumn M Thompson, MS, RD, LDN
• Ashley Quinn Thorburn, M.D.

• Pharmacist in Travis Afb, CA
• Providers in Travis Afb, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.