{
"Npi": {
"NPI": "1922141555",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BERRY",
"FirstName": "SHANNON",
"MiddleName": "LEE JETT",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "MA, CCC-SLP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1586 COUNTY ROAD 543A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUMTERVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33585-5125",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-568-0506",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "218 N FLORIDA ST",
"SecondLinePracticeLocationAddress": "SUITE 3",
"PracticeLocationAddressCityName": "BUSHNELL",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33513-6150",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-793-4512",
"PracticeLocationAddressFaxNumber": "352-793-4519",
"EnumerationDate": "02/14/2007",
"LastUpdateDate": "04/30/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "SA6623",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}