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1093161911 NPI number — SHAYLA J DRISKELL I SUDP

NPI Number: 1093161911
Health Care Provider/Practitioner: SHAYLA J DRISKELL I SUDP

Information about “1093161911” NPI (SHAYLA J DRISKELL I SUDP) exists in 1093161911 in HTML format HTML  |  1093161911 in plain Text format TXT  |  1093161911 in PDF (Portable Document Format) PDF  |  1093161911 in an XML format XML  formats.

NPI Number : 1093161911 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093161911",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DRISKELL",
    "FirstName": "SHAYLA",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": "I",
    "Credential": "SUDP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "25944 COMMUNITY PLAZA WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEDRO WOOLLEY",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98284-9702",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "360-854-7090",
    "MailingAddressFaxNumber": "360-854-7101",
    "FirstLinePracticeLocationAddress": "25704 COYOTE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SEDRO WOOLLEY",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98284-9085",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "360-854-7090",
    "PracticeLocationAddressFaxNumber": "360-854-7101",
    "EnumerationDate": "05/10/2016",
    "LastUpdateDate": "01/22/2026",
    "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": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "60229251",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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