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1922863794 NPI number — DEBRA JOAN SHANLEY

NPI Number: 1922863794
Health Care Provider/Practitioner: DEBRA JOAN SHANLEY

Information about “1922863794” NPI (DEBRA JOAN SHANLEY) exists in 1922863794 in HTML format HTML  |  1922863794 in plain Text format TXT  |  1922863794 in PDF (Portable Document Format) PDF  |  1922863794 in an XML format XML  formats.

NPI Number : 1922863794 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922863794",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHANLEY",
    "FirstName": "DEBRA",
    "MiddleName": "JOAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2500 MOWRY AVE STE 130",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FREMONT",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94538-1605",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-790-1911",
    "MailingAddressFaxNumber": "510-505-1960",
    "FirstLinePracticeLocationAddress": "2500 MOWRY AVE STE 130",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FREMONT",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94538-1605",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-790-1911",
    "PracticeLocationAddressFaxNumber": "510-505-1960",
    "EnumerationDate": "02/20/2024",
    "LastUpdateDate": "02/20/2024",
    "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": "224900000X",
        "TaxonomyName": "Mastectomy Fitter",
        "LicenseNumber": "C52324",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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