Misty Shadduck, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN301121 Issued in PA

Practice address

455 N Mesa Dr Ste 8E
Mesa, AZ 85201-5996

Phone

(937) 768-2544

Fax

(877) 991-6652

NPI assigned

Jan 5, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pimri, LLC

  • Pediatrics Physician
  • Mesa, AZ
  • NPI 1225660467
  NPD

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

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1043080476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 S VAL VISTA DR # A3-618",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852961374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 N MESA DR STE 8E",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852015996",
            "telephone_number": "937-768-2544",
            "fax_number": "877-991-6652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADDUCK",
        "first_name": "MISTY",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "32549101",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN301121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin L Seymour, PA-C
• Steven Seymour, FNP-C
• Erica E. Sezate, PA-C
• Genesis Sezate, PHARMD
• Nadeem Shabbir, MD
• Shahzad Shadmany, MD
• James W Shafer, MD
• Rod Shafer, R.PH.
• Lisa Shaffer
• Bhavish Shah, MD

• Licensed Practical Nurse in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Licensed Practical Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.