NPIMap

Individual provider Active NPI

Shelby Randolph, RDH

  • Dental Hygienist
  • MC Cook, NE
National Provider Identifier
1982249900
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
2422 Issued in NE
Practice address
2009 W J St
MC Cook, NE 69001-3090
Phone
(308) 345-2273
NPI assigned
Nov 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X 2422 NE Primary

Addresses

Primary practice location

2009 W J St
MC Cook, NE 69001-3090

Mailing address

2009 W J St
MC Cook, NE 69001-3090
Phone (308) 345-2273

Other names 1

  • Shelby Woitaszewski Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2422NEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kaitlin Haag DDS PC CurrentSince Jun 9, 2024 Accepting new patients

Locations

2009 W J St
McCook, NE 69001
Phone (308) 345-2273

411 W 5th St
McCook, NE 69001
Phone (308) 345-1510

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1982249900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 W J ST",
            "city": "MC COOK",
            "state": "NE",
            "postal_code": "690013090",
            "telephone_number": "308-345-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 W J ST",
            "city": "MC COOK",
            "state": "NE",
            "postal_code": "690013090",
            "telephone_number": "308-345-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "SHELBY",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-13",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "NE",
            "license": "2422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "WOITASZEWSKI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in MC Cook, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; 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.