Provider Demographics
NPI:1083046833
Name:MCTEAGUE, SHAYLYN KATHLEEN (DPM)
Entity Type:Individual
Prefix:MISS
First Name:SHAYLYN
Middle Name:KATHLEEN
Last Name:MCTEAGUE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:148 SAMUEL AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-1624
Mailing Address - Country:US
Mailing Address - Phone:860-389-1143
Mailing Address - Fax:
Practice Address - Street 1:20 CUMBERLAND HILL RD UNIT 210
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895
Practice Address - Country:US
Practice Address - Phone:401-356-4262
Practice Address - Fax:401-356-4369
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP89597213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1083046833Medicaid