1740205780 NPI number — DR. CATHERINE E. SHANAHAN M.D.

Table of content: MS. CATHERINE HARGROVE MS (NPI 1629346937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740205780 NPI number — DR. CATHERINE E. SHANAHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHANAHAN
Provider First Name:
CATHERINE
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1740205780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8989 S ORANGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32824-7904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-339-1976
Provider Business Mailing Address Fax Number:
407-386-7383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8989 S ORANGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32824-7904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-339-1976
Provider Business Practice Location Address Fax Number:
407-386-7383
Provider Enumeration Date:
07/12/2006

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: 207Q00000X , with the licence number:  MD-11164 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: C54747 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 0055110 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 55955 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 49577201 . This is a "ALOHACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: G48893 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00071255 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: MD11164-01 . This is a "LONGS/MDX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2494488 . This is a "UHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 49577201 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A0224863 . This is a "HMSA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 99-0262194 . This is a "HMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 99-0262194 . This is a "HMAA" identifier . This identifiers is of the category "OTHER".