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1902693971 NPI number — SHANNON ELSIE LEE DUFFY

NPI Number: 1902693971
Health Care Provider/Practitioner: SHANNON ELSIE LEE DUFFY

Information about “1902693971” NPI (SHANNON ELSIE LEE DUFFY) exists in 1902693971 in HTML format HTML  |  1902693971 in plain Text format TXT  |  1902693971 in PDF (Portable Document Format) PDF  |  1902693971 in an XML format XML  formats.

NPI Number : 1902693971 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902693971",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DUFFY",
    "FirstName": "SHANNON",
    "MiddleName": "ELSIE LEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ARMSTRONG",
    "OtherFirstName": "SHANNON",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1622 E MARINE VIEW DR APT E107",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EVERETT",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98201-2073",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-281-1182",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2821 MISSION HILL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TULALIP",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98271-9706",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "607-164-4003",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/23/2025",
    "LastUpdateDate": "04/23/2025",
    "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": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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