{
"Npi": {
"NPI": "1093112898",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MCDERMOTT",
"FirstName": "SHANTAI",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "285 FARENHOLT AVE STE 303",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TAMUNING",
"MailingAddressStateName": "GU",
"MailingAddressPostalCode": "96913-3223",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "671-998-3344",
"MailingAddressFaxNumber": "816-293-3324",
"FirstLinePracticeLocationAddress": "790 GOV CARLOS G CAMACHO RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TAMUNING",
"PracticeLocationAddressStateName": "GU",
"PracticeLocationAddressPostalCode": "96913-3129",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "671-647-5440",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/24/2014",
"LastUpdateDate": "02/02/2026",
"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": "363LA2200X",
"TaxonomyName": "Adult Health Nurse Practitioner",
"LicenseNumber": "ARNP9338371",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "ARNP9338371",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "198254",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "100462",
"LicenseNumberStateCode": "GU",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LA2200X",
"TaxonomyName": "Adult Health Nurse Practitioner",
"LicenseNumber": "198254",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "100462",
"LicenseNumberStateCode": "GU",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LA2200X",
"TaxonomyName": "Adult Health Nurse Practitioner",
"LicenseNumber": "100462",
"LicenseNumberStateCode": "GU",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "ARNP9338371",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "198254",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}