Anthony Shattuck, SOIDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

2D Marine Special Operations Battalion
PSC 20183
Camp Lejeune, NC 28542

Phone

(910) 450-7704

NPI assigned

Nov 6, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1225929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225929600000",
    "number": "1780838524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2D MARINE SPECIAL OPERATIONS BATTALION",
            "address_2": "PSC BOX 20183",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "28542",
            "telephone_number": "910-450-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2D MARINE SPECIAL OPERATIONS BATTALION",
            "address_2": "PSC 20183",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "28542",
            "telephone_number": "910-450-7704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "ANTHONY",
        "credential": "SOIDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-06",
        "last_updated": "2008-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Senbertrand, CSP
• Mena A Shaker, MD, DO
• Jordan Shankle
• Mohamed H Sharaf, MD
• Swapnil Sharma, D.O.
• James Allan Shaul, D.D.S.
• Matthew Francis Shea, OTR/L
• Crystal Shelton, LCSW
• Steve Michael Shelton, O.D.
• Kyle Shepard, AU.D.

• Independent Duty Corpsman in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• Independent Duty Corpsman in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2008; 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.