Shade Medical and Creative Tattoo LLC

Primary specialty

Medical Art Specialist/TechnologistTaxonomy code 246ZA2600X

Legal business name

SHADE MEDICAL AND CREATIVE TATTOO LLC

Doing business as

Shade Tattoo Studio

Practice address

3230 University Ave Ste 12
Madison, WI 53705-3540

Phone

(608) 571-2617

NPI assigned

Jun 19, 2019

Last updated

Jun 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alissa Christine WatersNPI 1730611468

Title

Owner/Tattooist

Phone

(608) 770-5682

Specialties & licenses 1

Addresses

Other names 1

• Shade Tattoo Studio Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alissa C Waters

  • Medical Art Specialist/Technologist
  • Madison, WI
  • NPI 1730611468

  Art, Medical

  NPD Authorized official

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560902400000",
    "number": "1548820731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 WESTCHESTER RD",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537114370",
            "telephone_number": "608-770-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3230 UNIVERSITY AVE STE 12",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537053540",
            "telephone_number": "608-571-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADE MEDICAL AND CREATIVE TATTOO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-19",
        "last_updated": "2019-06-19",
        "status": "A",
        "authorized_official_last_name": "WATERS",
        "authorized_official_first_name": "ALISSA",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER/TATTOOIST",
        "authorized_official_telephone_number": "608-770-5682"
    },
    "taxonomies": [
        {
            "code": "246ZA2600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Art, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shade Tattoo Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yashica Elkolyn Seymour, MD
• Trisha Marie Seys Ranola, PHARMD
• Nadine Maya Shabeeb, MD
• Samuel Shabtaie, MD
• Amber L Shada, MD
• Kelsey L Shadel, APNP, AGPCNP-BC
• Anthony M Shadid, MD
• Kristin Anneliese Shadman, MD
• Shawyon Shadman, M.D.
• David A Shafique, M.D.

• Medical Art Specialist/Technologist in Madison, WI
• Providers in Madison, WI by specialty
• Medical Art Specialist/Technologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; 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.