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1083046833 NPI number — SHAYLYN KATHLEEN MCTEAGUE D.P.M

NPI Number: 1083046833
Health Care Provider/Practitioner: SHAYLYN KATHLEEN MCTEAGUE D.P.M

Information about “1083046833” NPI (SHAYLYN KATHLEEN MCTEAGUE D.P.M) exists in 1083046833 in HTML format HTML  |  1083046833 in plain Text format TXT  |  1083046833 in PDF (Portable Document Format) PDF  |  1083046833 in an XML format XML  formats.

NPI Number : 1083046833 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083046833",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCTEAGUE",
    "FirstName": "SHAYLYN",
    "MiddleName": "KATHLEEN",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "D.P.M",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "148 SAMUEL AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PAWTUCKET",
    "MailingAddressStateName": "RI",
    "MailingAddressPostalCode": "02860-1624",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-389-1143",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "20 CUMBERLAND HILL RD UNIT 210",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOONSOCKET",
    "PracticeLocationAddressStateName": "RI",
    "PracticeLocationAddressPostalCode": "02895",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "401-356-4262",
    "PracticeLocationAddressFaxNumber": "401-356-4369",
    "EnumerationDate": "08/04/2013",
    "LastUpdateDate": "08/15/2018",
    "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": "213ES0103X",
        "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
        "LicenseNumber": "P89597",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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