MEDICARE: DR. BRAIDY CAITLIN SHAMBAUGH D.O.

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	207X00000X	Orthopaedic Surgery Physician	OT014250	NJ
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	DO00883	RI

General Provider Information

NPI Number	:	1972898773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAIDY CAITLIN SHAMBAUGH D.O.

Provider Business Mailing Address
First Line	:	725 RESERVOIR AVE
Second Line	:	STE 101
City	:	CRANSTON
State	:	RI
Zip	:	02910-4450
Country	:	US
Telephone Number	:	401-944-0228
Fax Number	:	401-944-1342

Provider Business Practice Location Address
First Line	:	4170 CITY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1610
Country	:	US
Telephone Number	:	215-871-6690
Fax Number	:

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

Provider Enumeration Date	:	06/09/2011
Last Update Date	:	07/28/2017

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