Traci Anne Shambo, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

2012040673 Issued in MO

Practice address

BLDG. 400 Virginia Ave
Fort Leonard Wood, MO 65473

Phone

(573) 596-0408

NPI assigned

Jun 19, 2018

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1982198453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22964 REVELATION RD",
            "city": "WAYNESVILLE",
            "state": "MO",
            "postal_code": "655837827",
            "telephone_number": "724-496-6814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG. 400 VIRGINIA AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "65473",
            "telephone_number": "573-596-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMBO",
        "first_name": "TRACI",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "MO",
            "license": "2012040673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karry A Schubert, RPH
• Sean Eliot Scott, MD
• August Christopher Seeber, PA-C
• Jerry P Seiler, MD
• James Thomas Sellers V
• Anne Sheahan
• Rebecca Shepard
• Christina Ann Shepherd
• Alma Delia Short
• Mark S Short, PA-C

• Dental Hygienist in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Dental Hygienist in Missouri

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