NPI Code Detail JSON Logo

1922120591 NPI number — SHYTAURA A GOSTON R.O.T,

NPI Number: 1922120591
Health Care Provider/Practitioner: SHYTAURA A GOSTON R.O.T,

Information about “1922120591” NPI (SHYTAURA A GOSTON R.O.T,) exists in 1922120591 in HTML format HTML  |  1922120591 in plain Text format TXT  |  1922120591 in PDF (Portable Document Format) PDF  |  1922120591 in an XML format XML  formats.

NPI Number : 1922120591 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922120591",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOSTON",
    "FirstName": "SHYTAURA",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "R.O.T,",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5333 S MICHIGAN AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60615-4604",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-895-9738",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "444 N WELLS ST STE 304",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60610-4593",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-494-9936",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/04/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "225X00000X",
        "TaxonomyName": "Occupational Therapist",
        "LicenseNumber": "056005224",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.