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General NPI Number Information
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NPI Number | 1093112898
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Entity Type | Individual
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Provider Name | SHANTAI MCDERMOTT DNP
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 790 GOV CARLOS G CAMACHO RD
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City | TAMUNING
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State | GU
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Zip | 96913-3129
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Country | US
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Telephone | 671-647-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 285 FARENHOLT AVE STE 303
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City | TAMUNING
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State | GU
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Zip | 96913-3223
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Country | US
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Telephone | 671-998-3344
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Fax | 816-293-3324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP9338371
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | ARNP9338371
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 198254
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 100462
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License Number State | GU
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Taxonomy #5
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 198254
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License Number State | AK
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 100462
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License Number State | GU
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Taxonomy #7
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 100462
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License Number State | GU
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Taxonomy #8
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | ARNP9338371
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License Number State | FL
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Taxonomy #9
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 198254
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License Number State | AK
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