Healthcare Provider Details

I. General information

NPI: 1114167319
Provider Name (Legal Business Name): SHAUNDA MARIE FARRINGTON RT(R)(M) RPA/RA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WOODRIDGE CT
DECATUR IL
62526-1390
US

IV. Provider business mailing address

3339 N DELL OAK DR
DECATUR IL
62526-1304
US

V. Phone/Fax

Practice location:
  • Phone: 614-725-6487
  • Fax:
Mailing address:
  • Phone: 614-725-6487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number500508780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: