Active NPI
Shaylie Jackson
- Other Technician
- Virginia Beach, VA
National Provider Identifier
1497145189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 0230023817
- Practice address
- 525 First Colonial Rd
Virginia Beach, VA 23451-6119 - Phone
- (757) 428-2666
- Fax
- (757) 451-7307
- NPI assigned
- Feb 2, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 0230023817 | VA | Primary |
Addresses
Primary practice location
525 First Colonial Rd
Virginia Beach, VA 23451-6119
Mailing address
525 First Colonial Rd
Virginia Beach, VA 23451-6119
Phone (757) 428-2666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0230023817 | VA | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422835200000",
"number": "1497145189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 FIRST COLONIAL RD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234516119",
"telephone_number": "757-428-2666",
"fax_number": "757-451-7307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 FIRST COLONIAL RD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234516119",
"telephone_number": "757-428-2666",
"fax_number": "757-451-7307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SHAYLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-02",
"last_updated": "2015-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "VA",
"license": "0230023817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.