Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane Wakefield

Individual provider Physician Assistant · NPI 1487345823

Shane Wakefield is a Physician Assistant in Sparks, Nevada. Qualified in 2024, 2 years ago. Practices with Northern Nevada Medical Group LLC, a 87-clinician group and accepts Medicare assignment. Licensed in California and Nevada.

Years since qualifying
2
Licensed in
CA, NV
In the registry since
2023
Specialties on file
3

Practice location Address checks out

2375 E Prater Way
Sparks, NV 89434-9641
Phone: (775) 331-7000
Fax: (775) 352-5303
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA3190 (NV)
Physician Assistant Taxonomy 363A00000X
Physician Assistant Taxonomy 363A00000X · Licence PA65106 (CA)

Record details

NPI number1487345823
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 17, 2023
Last updated in NPPESJuly 23, 2026
Certification dateJuly 23, 2026
Mailing address2375 E Prater Way, Sparks, NV 89434-9641

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Northern Nevada Medical Group Llc — 87 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Sparks