JARREL LYNNE SHACKLEFORD (NPI# 1548559099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548559099 |
| Entity Type | Individual |
| Full Name | JARREL LYNNE SHACKLEFORD |
| Other Name | JARREL LYNNE TUSTIN |
| Credential | PA-C |
| Practice Address |
207 Quaker Ln West Warwick RI 02893-2283 |
| Mailing Address |
2234 Colonial Blvd Attn: Payer Contracting & Relations Fort Myers FL 33907-1412 |
| Practice Telephone | 4018287110 |
| Practice Fax Number | 4018276364 |
| Mailing Telephone | 2399317342 |
| Mailing Fax Number | 2399317385 |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2014-02-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA00580 | RI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | AETNA | 4744074 | 01 |
| RI | NEIGHBORHOOD HEALTH PLAN | 1548559099 | 01 |
| Street Address |
207 QUAKER LN |
| City | WEST WARWICK |
| State | RI |
| Zip Code | 02893-2283 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346245305 | Joseph Cosmo Cambio | Specialist | 207 Quaker Ln, West Warwick, RI 02893-2283 | 2005-06-16 |
| 1326672312 | Anesthesia Partners of New England, LLC | Nurse Anesthetist, Certified Registered | 207 Quaker Ln, West Warwick, RI 02893-2283 | 2020-02-27 |
| 1851725535 | Roger Williams Radiation Therapy LLC | Urology | 207 Quaker Ln, 1st Floor, West Warwick, RI 02893-2283 | 2013-08-29 |
| 1457795015 | Alexander Lubin | Urology | 207 Quaker Ln, West Warwick, RI 02893-2283 | 2013-04-24 |
| 1841521507 | Sa-id Esfahanian | Pathology | 207 Quaker Ln, West Warwick, RI 02893-2179 | 2010-01-20 |
| 1811168164 | Urologic Specialists of New England LLC | Clinic/Center | 207 Quaker Ln, 1st Floor, West Warwick, RI 02893-2179 | 2008-03-14 |
| 1558428540 | Joseph A Cambio | Urology | 207 Quaker Ln, West Warwick, RI 02893-2283 | 2007-01-02 |
| 1760559033 | Dora K. Clark | Physician Assistant | 207 Quaker Ln, West Warwick, RI 02893-2283 | 2006-11-29 |
| 1508879610 | Angelo J Cambio | Urology | 207 Quaker Ln, West Warwick, RI 02893-2283 | 2006-08-14 |
| 1679555395 | Joseph C Cambio Md Ltd | Urology | 207 Quaker Ln, 1st Floor, West Warwick, RI 02893 | 2005-11-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528596012 | Nicholas James Ferro | Social Worker | 125 Providence St Unit N403, West Warwick, RI 02893 | 2017-05-26 |
| 1255636486 | Kathleen Ann Glancy | Registered Nurse | 4 Silverwood Lane, West Warwick, RI 02893 | 2011-01-19 |
| 1659549764 | Kerri Lynn Kyriakakis | Counselor | 1 James P. Murphy Highway, West Warwick, RI 02893 | 2008-02-12 |
| 1962685263 | Granite Harbor Business Development LLC | Point of Service | 1 James P. Murphy Industrial Highway, West Warwick, RI 02893 | 2007-12-10 |
| 1497811707 | Luann M Kelly | Registered Nurse | 37 Washington Street, West Warwick, RI 02893 | 2006-12-29 |
| 1679638530 | Vantage Point | Exclusive Provider Organization | 1 James P Murphy Highway, Suite 103, West Warwick, RI 02893 | 2006-12-22 |
| 1528123478 | Kathleenn Ann Carty | Counselor | 1james P. Murphy Highway, Suite 103, West Warwick, RI 02893 | 2006-12-22 |
| 1972672699 | Lee S Lovitz | Podiatrist | 1193 Tiogue Avenue, Coventry, RI 02893 | 2006-11-07 |
| 1003901497 | Mary Rose | Nurse Practitioner | 186 Providence Street, West Warwick, RI 02893 | 2006-10-03 |
| 1477659795 | Sandra Ann Wheller | Registered Nurse | Kent Center Mtt 2, West Warwick, RI 02893 | 2006-09-15 |
| Find all providers in zip 02893 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770019770 | Erin K. Machado | Physician Assistant | 207 Quaker Ln Fl 1, West Warwick, RI 02893-2179 | 2017-05-11 |
| 1760559033 | Dora K. Clark | Physician Assistant | 207 Quaker Ln, West Warwick, RI 02893-2283 | 2006-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619580156 | Alana M Oster | Physician Assistant | 129 Chapel St, Lincoln, RI 02865-2119 | 2020-08-25 |
| 1962011411 | Phoebe Hughes | Physician Assistant | 310 Crompton Rd, East Greenwich, RI 02818-1200 | 2020-07-29 |
| 1033736970 | Alyssa Natale Friedman | Physician Assistant | 115 Jacksonia Dr, North Providence, RI 02911-1224 | 2020-06-26 |
| 1306462502 | Sara Jeanne Mcdole | Physician Assistant | 225 Central St, Harrisville, RI 02830-1536 | 2020-06-23 |
| 1508481755 | Kelly Maloney | Physician Assistant | 520 Smithfield Rd Apt 203, North Providence, RI 02904-8931 | 2020-06-13 |
| 1083239495 | Megan Rotondo | Physician Assistant | 96 Orchard Meadows Dr, Smithfield, RI 02917-1846 | 2020-06-11 |
| 1407471105 | Dylan Gene Godyn | Physician Assistant | 9 Summer Ct, Smithfield, RI 02917-1868 | 2020-06-09 |
| 1346864139 | Helen Nguyen | Physician Assistant | 1143 Chopmist Hill Rd, North Scituate, RI 02857-1048 | 2020-06-08 |
| 1922622265 | Jacob H. Sosa | Physician Assistant | 11 Amy St, Providence, RI 02906-3802 | 2020-06-02 |
| 1619591070 | Alexandra L Conrad | Physician Assistant | 48 Gaspee Point Dr, Warwick, RI 02888-4918 | 2020-06-02 |
| Find all providers with the same taxonomy | ||||
| City | WEST WARWICK |
| Zip Code | 02893 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.