1598163321 NPI number — JOYE W SHANTEAU PH.D.

Table of content: JOYE W SHANTEAU PH.D. (NPI 1598163321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598163321 NPI number — JOYE W SHANTEAU PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHANTEAU
Provider First Name:
JOYE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598163321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 WULFF DR
Provider Second Line Business Mailing Address:
NONE
Provider Business Mailing Address City Name:
OCEAN SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39564-4544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-806-3220
Provider Business Mailing Address Fax Number:
228-875-4372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 WULFF DR
Provider Second Line Business Practice Location Address:
NONE
Provider Business Practice Location Address City Name:
OCEAN SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39564-4544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-806-3220
Provider Business Practice Location Address Fax Number:
228-875-4372
Provider Enumeration Date:
12/10/2014

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: 103TC0700X , with the licence number:  29-414 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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