1972027217 NPI number — RAIYAWNA SHAUNDELL GATLIN D.C.

Table of content: RAIYAWNA SHAUNDELL GATLIN D.C. (NPI 1972027217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972027217 NPI number — RAIYAWNA SHAUNDELL GATLIN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GATLIN
Provider First Name:
RAIYAWNA
Provider Middle Name:
SHAUNDELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1972027217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/04/2026
NPI Reactivation Date:
07/22/2026

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2912 N MACARTHUR BLVD STE 113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75062-4489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-565-2221
Provider Business Mailing Address Fax Number:
469-947-6097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2912 N MACARTHUR BLVD STE 113
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75062-4489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-565-2221
Provider Business Practice Location Address Fax Number:
469-947-6097
Provider Enumeration Date:
07/28/2017

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: 111N00000X , with the licence number:  16849 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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