MEDICARE: DR. SHANTAI MCDERMOTT DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP9338371	FL
2	363LG0600X	Gerontology Nurse Practitioner	ARNP9338371	FL
3	363LG0600X	Gerontology Nurse Practitioner	198254	AK
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9338371	FL
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	198254	AK
6	363LA2200X	Adult Health Nurse Practitioner	198254	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093112898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTAI MCDERMOTT DNP

Provider Business Mailing Address
First Line	:	3523 MOUNTAIN VIEW DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-1111
Country	:	US
Telephone Number	:	907-222-2621
Fax Number	:

Provider Business Practice Location Address
First Line	:	3523 MOUNTAIN VIEW DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-1111
Country	:	US
Telephone Number	:	907-222-2621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	11/02/2023

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