NPI Code Detail JSON Logo

1083060917 NPI number — SHELLY STEPHENS GROENENDYK MD

NPI Number: 1083060917
Health Care Provider/Practitioner: SHELLY STEPHENS GROENENDYK MD

Information about “1083060917” NPI (SHELLY STEPHENS GROENENDYK MD) exists in 1083060917 in HTML format HTML  |  1083060917 in plain Text format TXT  |  1083060917 in PDF (Portable Document Format) PDF  |  1083060917 in an XML format XML  formats.

NPI Number : 1083060917 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083060917",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GROENENDYK",
    "FirstName": "SHELLY",
    "MiddleName": "STEPHENS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "25 ROCKY HILL RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOUNT SINAI",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11766-1213",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-205-1033",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "75 N COUNTRY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORT JEFFERSON",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11777-2190",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-382-7399",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/10/2016",
    "LastUpdateDate": "11/03/2024",
    "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": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "10516430-1205",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "63603",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "329018",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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