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SHANE DAVID NIBLEY
NPI 1255200846
Rehabilitation Practitioner in South Lake Tahoe, CA

Active since November 01, 2025
3079 HARRISON AVE, SOUTH LAKE TAHOE, CA 96150(530) 957-6254 Get Directions Write a Review

NPPES record last updated: December 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shane David Nibley NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANE DAVID NIBLEY (NPI 1255200846) is an individual rehabilitation practitioner in South Lake Tahoe, California and active in the NPI registry since November 2025.

NPPES Registry Identity

NPI1255200846
Entity TypeIndividualMale
Primary Taxonomy225400000X
Provider Legal NameSHANE DAVID NIBLEY
Location Address3079 HARRISON AVESouth Lake Tahoe, CA 96150-7976
Mailing Address406 Sunrise Ave Ste 300Roseville, CA 95661-4144 · (916) 783-5207
Phone(530) 957-6254
Sole ProprietorNo
Enumeration DateNovember 1, 2025
Last NPPES UpdateDecember 11, 2025
NPPES CertifiedDecember 11, 2025
✔ NPI 1255200846 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyRehabilitation PractitionerRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225400000X
Definition
A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.
Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X
Also ListedDay Training/Habilitation SpecialistTaxonomy 373H00000X
3079 HARRISON AVE, South Lake Tahoe, CA 96150
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Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. ANDREA DAWN CARSONER-LANDRY
Behavior Technician
3079 HARRISON AVE
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 578-3839
DR. PATRICK LACKMANN TRAYNOR RD
Dietitian, Registered
3079 HARRISON AVE
SOUTH LAKE TAHOE, CA 96150
El Dorado County (909) 653-3471
MNT SCIENTIFIC
Dietitian, Registered
3079 HARRISON AVE
SOUTH LAKE TAHOE, CA 96150
El Dorado County (909) 653-3471
REBECCA RENEE ROJAS
Case Manager/Care Coordinator
3079 HARRISON AVE
SOUTH LAKE TAHOE, CA 96150
El Dorado County (510) 247-8300
JERAMY DANTZLER
Health Educator
3079 HARRISON AVE
SOUTH LAKE TAHOE, CA 96150
El Dorado County (530) 721-6920

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shane Nibley's NPI number?

The NPI number for Shane Nibley is 1255200846. It was assigned to this individual provider in the NPPES registry on November 1, 2025.

Where is Shane Nibley located?

Shane Nibley practices at 3079 Harrison Ave, South Lake Tahoe, CA 96150. The listed phone number is (530) 957-6254.

What is Shane Nibley's specialty?

The primary specialty registered for this NPI is Rehabilitation Practitioner with taxonomy code 225400000X.

When was this NPI record last updated?

The NPPES record for Shane Nibley was last updated on December 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.