Shastidy Pauline Lopez, CCSS

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

Practice address

1 Camino Oro CT
Tijeras, NM 87059-7924

Phone

(706) 593-8731

Fax

(706) 593-8732

NPI assigned

Jan 10, 2024

Last updated

Sep 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Shastidy Pauline Madrid Former name

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": "1704844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1962273854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45681",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871745681",
            "telephone_number": "505-226-1960",
            "fax_number": "505-672-7769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CAMINO ORO CT",
            "city": "TIJERAS",
            "state": "NM",
            "postal_code": "870597924",
            "telephone_number": "706-593-8731",
            "fax_number": "706-593-8732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "SHASTIDY",
        "middle_name": "PAULINE",
        "credential": "CCSS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHASTIDY",
            "last_name": "MADRID",
            "middle_name": "PAULINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Military Health Care Provider in Tijeras, NM
• Providers in Tijeras, NM by specialty
• Military Health Care Provider in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; 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.