Basic Information
Provider Information | |||||||||
NPI: | 1124245238 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEYHART | ||||||||
FirstName: | SHIRLEY | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | N.P. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LOUISSAINT | ||||||||
OtherFirstName: | SHILREY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | NP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 21 BRAMBLE BUSH DR | ||||||||
Address2: |   | ||||||||
City: | FALMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 025402325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5084955160 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 21 BRAMBLE BUSH DR | ||||||||
Address2: |   | ||||||||
City: | FALMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 025402325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5084955160 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2007 | ||||||||
LastUpdateDate: | 12/07/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 260865 | MA | N |   | Nursing Service Providers | Registered Nurse |   | 363LP2300X | RN260865 | MA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.