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NPI Code Detail

MEDICARE: SHANNON GAYDESKI

MEDICARE: SHANNON GAYDESKI
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
1174N00000XLactation Consultant (Non-RN)L-107778

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100000000OTHERN/A

General Provider Information

NPI Number : 1295329332
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON GAYDESKI
Provider Business Mailing Address
First Line : 310 NEW BRIDGE ST
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-4756
Country : US
Telephone Number : 910-621-4266
Fax Number : 910-613-0382
Provider Business Practice Location Address
First Line : 310 NEW BRIDGE ST
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-4756
Country : US
Telephone Number : 910-621-4266
Fax Number : 910-613-0382
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2021
Last Update Date : 03/01/2021

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