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NPI Code Detail

MEDICARE: DR. SHANTAI MCDERMOTT DNP

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
1363LA2200XAdult Health Nurse PractitionerARNP9338371FL
2363LG0600XGerontology Nurse PractitionerARNP9338371FL
3363LP0808XPsychiatric/Mental Health Nurse Practitioner198254AK
4363LG0600XGerontology Nurse Practitioner100462GU
5363LA2200XAdult Health Nurse Practitioner198254AK
6363LP0808XPsychiatric/Mental Health Nurse Practitioner100462GU
7363LA2200XAdult Health Nurse Practitioner100462GU
8363LP0808XPsychiatric/Mental Health Nurse PractitionerARNP9338371FL
9363LG0600XGerontology Nurse Practitioner198254AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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 : 285 FARENHOLT AVE STE 303
Second Line :
City : TAMUNING
State : GU
Zip : 96913-3223
Country : US
Telephone Number : 671-998-3344
Fax Number : 816-293-3324
Provider Business Practice Location Address
First Line : 790 GOV CARLOS G CAMACHO RD
Second Line :
City : TAMUNING
State : GU
Zip : 96913-3129
Country : US
Telephone Number : 671-647-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2014
Last Update Date : 02/02/2026

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