1902323835 NPI number — MRS. SHANNON PAISLEY LCAT, ATRBC

Table of content: MRS. SHANNON PAISLEY LCAT, ATRBC (NPI 1902323835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902323835 NPI number — MRS. SHANNON PAISLEY LCAT, ATRBC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAISLEY
Provider First Name:
SHANNON
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCAT, ATRBC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARIA
Provider Other First Name:
SHANNON
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902323835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
328 MAIN ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01550-3795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
19145723015
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 MAIN ST. #1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHBRIDGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
01550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
19145723015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2017

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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