1144225152 NPI number — DR. LINDA SUE SHENKLE OD

Table of content: DR. LINDA SUE SHENKLE OD (NPI 1144225152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144225152 NPI number — DR. LINDA SUE SHENKLE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHENKLE
Provider First Name:
LINDA
Provider Middle Name:
SUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOCK
Provider Other First Name:
LINDA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144225152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 WAYNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14120-3442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-465-7139
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 NIAGARA FALLS BLVD
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14228-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-564-2020
Provider Business Practice Location Address Fax Number:
716-564-2060
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV005071-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 161578122 . This is a "NORTH AMERICAN PREFERRED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161578122 . This is a "NOVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000390043002 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02505984 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251744484 . This is a "EMPIRE - UNITED HEALTHCAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000390043004 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 251744484 . This is a "NOVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 410042274 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161578122 . This is a "EMPIRE - UNITED HEALTHCAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 251744484 . This is a "NORTH AMERICAN PREFERRED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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