Tina Lee Shade, MT

Primary specialty

SpecialistTaxonomy code 174400000X

License

02378 Issued in IA

Practice address

2255 JFK Rd
Dubuque, IA 52002-2846

Phone

(563) 583-3629

NPI assigned

Jan 8, 2013

Last updated

Nov 14, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Credentials

Medical Technician

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

{
    "created_epoch": "1357603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542153600000",
    "number": "1871830018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 JFK RD",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520022846",
            "telephone_number": "563-583-3629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 JFK RD",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520022846",
            "telephone_number": "563-583-3629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADE",
        "first_name": "TINA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "MT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-08",
        "last_updated": "2018-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IA",
            "license": "02378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Chandler Severson
• Michelle Shafer, D.O.
• Roger D. Shafer, M.D.
• Benjamin Allen Shaw, L.I.S.W.
• Keith Alan Shaw, MD
• Shelby Anna Shelley

• Specialist in Dubuque, IA
• Providers in Dubuque, IA by specialty
• Specialist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; 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.