NPI Code Detail JSON Logo

1285817288 NPI number — SHELLY LEE MD

NPI Number: 1285817288
Health Care Provider/Practitioner: SHELLY LEE MD

Information about “1285817288” NPI (SHELLY LEE MD) exists in 1285817288 in HTML format HTML  |  1285817288 in plain Text format TXT  |  1285817288 in PDF (Portable Document Format) PDF  |  1285817288 in an XML format XML  formats.

NPI Number : 1285817288 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285817288",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEE",
    "FirstName": "SHELLY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LEE",
    "OtherFirstName": "SHELLY",
    "OtherMiddleName": "TINA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "427 S BERNARD ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPOKANE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99204-2509",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-456-0107",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "427 S BERNARD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPOKANE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99204-2509",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-456-0107",
    "PracticeLocationAddressFaxNumber": "509-747-2635",
    "EnumerationDate": "12/12/2007",
    "LastUpdateDate": "08/01/2024",
    "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": "207W00000X",
        "TaxonomyName": "Ophthalmology Physician",
        "LicenseNumber": "MD60998995",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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