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1811203276 NPI number — SARA SHKALIM SHISSIAS OD

NPI Number: 1811203276
Health Care Provider/Practitioner: SARA SHKALIM SHISSIAS OD

Information about “1811203276” NPI (SARA SHKALIM SHISSIAS OD) exists in 1811203276 in HTML format HTML  |  1811203276 in plain Text format TXT  |  1811203276 in PDF (Portable Document Format) PDF  |  1811203276 in an XML format XML  formats.

NPI Number : 1811203276 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811203276",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHISSIAS",
    "FirstName": "SARA",
    "MiddleName": "SHKALIM",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SHKALIM",
    "OtherFirstName": "SARA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "OD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "204 HADDON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST BERLIN",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "08091-1607",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "856-768-2515",
    "MailingAddressFaxNumber": "856-768-7451",
    "FirstLinePracticeLocationAddress": "204 HADDON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST BERLIN",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08091-1607",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "856-768-2515",
    "PracticeLocationAddressFaxNumber": "856-768-7451",
    "EnumerationDate": "08/24/2010",
    "LastUpdateDate": "02/09/2024",
    "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": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "OEG002407",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WL0500X",
          "TaxonomyName": "Low Vision Rehabilitation Optometrist",
          "LicenseNumber": "27OA00632300",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "27OA00632300",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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