Madelyn M Shasteen

Key facts

NPI

1891418554

Entity type

Individual (NPI type 1)

Primary specialty

Military Health Care Provider 171000000X

Practice address

60 W Sunbridge Dr
Fayetteville, AR 72703-1822

Phone

(479) 695-1240

NPI assigned

Sep 19, 2022

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 19, 2022.

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1891418554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 S 48TH ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626683",
            "telephone_number": "479-750-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 W SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727031822",
            "telephone_number": "479-695-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHASTEEN",
        "first_name": "MADELYN",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-19",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

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• Holly Rae Blevins Sharp, LPC
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• Brittany Belle Sharum, M.S. CCC-SLP
• Jonathan F Shaver, O.D.
• Paulette Lynn Sheagren, NP
• Anne Sheen, PA-C
• Kim R Sheets, APN
• Logan Sheets

All providers in Fayetteville, AR · Military Health Care Provider in Arkansas