Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 931 | NE |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 05-38208 | KS |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | OTO12165 | PA |
NPI | 1932356078 |
---|---|
Provider Name | Shaunda Marie Rodriguez |
First Address | Wichita, KS 67208-0035 |
Second Address | Wichita, KS 67206-3548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 01/07/2015 |