Dorothy Lorraine Shackleford

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

0001212718 Issued in VA

Practice address

3963 Hartlake St
Woodbridge, VA 22192-7477

Phone

(703) 590-2019

NPI assigned

Feb 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429747200000",
    "number": "1003888447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 SOUTH SERVICE ROAD",
            "address_2": "SUITE 350",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "115452358",
            "telephone_number": "516-945-3000",
            "fax_number": "516-945-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3963 HARTLAKE ST",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221927477",
            "telephone_number": "703-590-2019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKLEFORD",
        "first_name": "DOROTHY",
        "middle_name": "LORRAINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-01",
        "last_updated": "2015-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "598148",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0001212718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003888447",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01179302",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Certified Registered Nurse Anesthetist in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Certified Registered Nurse Anesthetist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.