Shantavis Shantrell Fayson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

5242314 Issued in FL

Practice address

2802 NE 53Rd CT # 194
Gainesville, FL 32609-2625

Phone

(850) 933-1399

NPI assigned

Jan 10, 2022

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": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1992466171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2802 NE 53RD CT # 194",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326092625",
            "telephone_number": "850-933-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2802 NE 53RD CT # 194",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326092625",
            "telephone_number": "850-933-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAYSON",
        "first_name": "SHANTAVIS",
        "middle_name": "SHANTRELL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-10",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "5242314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Alan Faver
• Jennifer Favor, APRN
• Nicole Favreau
• Sarah McMillen Fayad, M.D.
• Oluwaseun Fayiga
• Brian John Fazzone, MD
• FC Clinical Services of Florida PA
• Elizabeth Ann Feagin, LCSW
• William Feagle
• Patricia Morris Fearing, MD

• Licensed Practical Nurse in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; 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.