1831502384 NPI number — MRS. LINDSEY SHEA UNDERWOOD AU.D., CCC-A

Table of content: MRS. LINDSEY SHEA UNDERWOOD AU.D., CCC-A (NPI 1831502384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831502384 NPI number — MRS. LINDSEY SHEA UNDERWOOD AU.D., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNDERWOOD
Provider First Name:
LINDSEY
Provider Middle Name:
SHEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AU.D., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOODMAN
Provider Other First Name:
LINDSEY
Provider Other Middle Name:
SHEA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831502384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 NEW HOPE ROAD
Provider Second Line Business Mailing Address:
SUITE #19
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24740-2272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-487-2487
Provider Business Mailing Address Fax Number:
304-431-3367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 NEW HOPE ROAD
Provider Second Line Business Practice Location Address:
SUITE #19
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-2272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-487-2487
Provider Business Practice Location Address Fax Number:
304-431-3367
Provider Enumeration Date:
06/03/2014

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: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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