Provider Demographics
NPI:1942595228
Name:RIVARD, SHAYNA COLLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:COLLEEN
Last Name:RIVARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL MEDICAL CENTER PORTSMOUTH
Mailing Address - Street 2:DEPARTMENT OF DERMATOLOGY, 620 JOHN PAUL JONES CIRCLE
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708
Mailing Address - Country:US
Mailing Address - Phone:757-953-0291
Mailing Address - Fax:757-953-0862
Practice Address - Street 1:NAVAL MEDICAL CENTER PORTSMOUTH
Practice Address - Street 2:DEPARTMENT OF DERMATOLOGY, 620 JOHN PAUL JONES CIRCLE
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708
Practice Address - Country:US
Practice Address - Phone:757-953-0291
Practice Address - Fax:757-953-0862
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2023-07-18
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-03-20
Provider Licenses
StateLicense IDTaxonomies
NH22256207N00000X
VA0101252746207N00000X
TXT6024207N00000X
TNMD0000064760207N00000X
FLME144349207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101252746OtherVIRGINIA BOARD OF MEDICINE
TXT6024OtherTEXAS MEDICAL BOARD
NH22256OtherNEW HAMPSHIRE BOARD OF MEDICINE
TN0000064760OtherTENNESSEE DEPARTMENT OF HEALTH
FLME144349OtherFLORIDA DEPARTMENT OF HEALTH