Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | P89597 | NY |
NPI | 1083046833 |
---|---|
Provider Name | Miss Shaylyn Kathleen Mcteague |
First Address | Pawtucket, RI 02860-1624 |
Second Address | Woonsocket, RI 02895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2013 |
Last Update Date | 15/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083046833 | (05) | RI |