Provider Demographics
NPI:1114167319
Name:FARRINGTON, SHAUNDA MARIE (RT(R)(M) RPA/RA)
Entity Type:Individual
Prefix:
First Name:SHAUNDA
Middle Name:MARIE
Last Name:FARRINGTON
Suffix:
Gender:F
Credentials:RT(R)(M) RPA/RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 N DELL OAK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-1304
Mailing Address - Country:US
Mailing Address - Phone:614-725-6487
Mailing Address - Fax:
Practice Address - Street 1:1250 WOODRIDGE CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-1390
Practice Address - Country:US
Practice Address - Phone:614-725-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID247100000X, 2471C3402X, 2471M2300X
IL500508780243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography