NPI |
1588968895 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
SHELBY |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider First Name |
SHALITHA |
The first name of the provider, if the provider
is an individual. |
Provider Name Prefix Text |
MS. |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider First Line Business Practice Location Address |
3917 ORLANDO SPRINGS DR |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
FORT WORTH |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address State Name |
TX |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
761231485 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
8177291150 |
The country code in the location address of the provider being identified. |
Provider Enumeration Date |
12/29/2010 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
10/12/2012 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
311ZA0620X |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
320600000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
Healthcare Provider Taxonomy Code 3 |
320800000X |
|
Healthcare Provider Primary Taxonomy Switch 3 |
N |
|
Healthcare Provider Taxonomy Code 4 |
320900000X |
|
Healthcare Provider Primary Taxonomy Switch 4 |
N |
|
Healthcare Provider Taxonomy Code 5 |
343900000X |
|
Healthcare Provider Primary Taxonomy Switch 5 |
N |
|
Healthcare Provider Taxonomy Code 6 |
347C00000X |
|
Healthcare Provider Primary Taxonomy Switch 6 |
N |
|
Healthcare Provider Taxonomy Code 7 |
385H00000X |
|
Healthcare Provider Primary Taxonomy Switch 7 |
N |
|
Healthcare Provider Taxonomy Code 8 |
385HR2050X |
|
Provider License Number State Code 8 |
TX |
|
Healthcare Provider Primary Taxonomy Switch 8 |
N |
|
Healthcare Provider Taxonomy Code 9 |
385HR2050X |
|
Healthcare Provider Primary Taxonomy Switch 9 |
N |
|
Healthcare Provider Taxonomy Code 10 |
385HR2060X |
|
Healthcare Provider Primary Taxonomy Switch 10 |
N |
|
Healthcare Provider Taxonomy Code 11 |
385HR2065X |
|
Healthcare Provider Primary Taxonomy Switch 11 |
N |
|
Healthcare Provider Taxonomy Code 12 |
172V00000X |
|
Healthcare Provider Primary Taxonomy Switch 12 |
N |
|
Healthcare Provider Taxonomy Code 13 |
171M00000X |
|
Healthcare Provider Primary Taxonomy Switch 13 |
Y |
|
Healthcare Provider Taxonomy Code 14 |
251S00000X |
|
Healthcare Provider Primary Taxonomy Switch 14 |
N |
|
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |