SHAYNE TYLER STANLEY (NPI# 1275007791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275007791 |
| Entity Type | Individual |
| Full Name | SHAYNE TYLER STANLEY |
| Practice Address |
2600 Dodson St Ste 3 Port Hueneme CA 93043-4432 |
| Mailing Address |
2211 Pacific Beach Dr San Diego CA 92109-5626 |
| Practice Telephone | 6617940954 |
| Mailing Telephone | 6617940954 |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2019-01-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DRIVER LICENSE | D9195737 | 01 |
| Street Address |
2600 DODSON ST STE 3 |
| City | PORT HUENEME |
| State | CA |
| Zip Code | 93043-4432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235478728 | Gregory A Williams | Military Health Care Provider | 2600 Dodson St Ste 3, Port Hueneme, CA 93043-4432 | 2013-02-04 |
| 1831702950 | Kyle Leonard Gosselin | Military Health Care Provider | 2600 Dodson St Ste 3, Port Hueneme, CA 93043-4432 | 2020-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558852921 | Ryan Kitchens | Military Health Care Provider | 4643 Dock Road Building 524, Port Hueneme, CA 93043 | 2018-05-22 |
| 1881952661 | Underwater Construction Team Two | Military/U.S. Coast Guard Transport | 4643 Dock Road Bldg 524, Underwater Construction Team Two, Port Hueneme, CA 93043 | 2012-04-30 |
| 1528037108 | Thomas A Colp | Optometrist | 162 First Street, Port Hueneme, CA 93043 | 2006-03-16 |
| 1033184874 | Erwin Lee Hoffman | Pediatrics | 162 First St, Port Hueneme Amulatory Clinic Navy Base, Port Hueneme, CA 93043 | 2006-02-22 |
| 1366412157 | William Malcolm Brown IIi | Family Medicine | 1436 Pacific Avenue, Port Hueneme, CA 93043 | 2006-01-24 |
| 1316334717 | Naval Hospital Camp Pendleton | Military/U.S. Coast Guard Pharmacy | 162 1st St Bldg 1402, Port Hueneme, CA 93043 | 2015-04-23 |
| 1033506431 | Naval Hospital Camp Pendleton | Military/U.S. Coast Guard Pharmacy | 162 1st St Bldg 1402, Port Hueneme, CA 93043 | 2015-04-23 |
| 1740385095 | Naval Hospital Camp Pendleton | Military/U.S. Coast Guard Pharmacy | 162 1st St, Naval Medical Center, Port Hueneme, CA 93043 | 2006-09-13 |
| 1871828723 | Seth T. Secrease | Military Health Care Provider | Naval Clinic Port Hueneme, 162 1st St, Port Hueneme, CA 93043-0001 | 2009-10-09 |
| 1396930129 | Shawn Jeremy Kern | Military Health Care Provider | Underwater Construction Team 2 Medical, 4643 Dock Road Bldg 524, Port Hueneme, CA 93043-0001 | 2007-09-14 |
| Find all providers in zip 93043 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558852921 | Ryan Kitchens | Military Health Care Provider | 4643 Dock Road Building 524, Port Hueneme, CA 93043 | 2018-05-22 |
| 1629592605 | Andrew Guilmond Nadeau | Military Health Care Provider | 1183 North Ventura Road, Port Hueneme, CA 93041 | 2017-08-01 |
| 1235478728 | Gregory A Williams | Military Health Care Provider | 2600 Dodson St Ste 3, Port Hueneme, CA 93043-4432 | 2013-02-04 |
| 1639424294 | Adam Joseph Newell | Military Health Care Provider | 1991 Pacific Rd, Port Hueneme, CA 93043-4306 | 2012-07-19 |
| 1093043051 | Erik Christian Ketelsen | Military Health Care Provider | 4653 Dock Rd, Bldg 524, Port Hueneme, CA 93043-4321 | 2009-12-01 |
| 1871828723 | Seth T. Secrease | Military Health Care Provider | Naval Clinic Port Hueneme, 162 1st St, Port Hueneme, CA 93043-0001 | 2009-10-09 |
| 1063682581 | Ryan T De La Cruz | Military Health Care Provider | Nmcb - 3 Unit 25269 Fpo Ap 96601, Port Hueneme, CA 96601 | 2008-03-12 |
| 1396930129 | Shawn Jeremy Kern | Military Health Care Provider | Underwater Construction Team 2 Medical, 4643 Dock Road Bldg 524, Port Hueneme, CA 93043-0001 | 2007-09-14 |
| 1376754242 | Joshua William Ross | Military Health Care Provider | Naval Ambulatory Care Clinic, 162 1st Street Building 1402, Port Hueneme, CA 93043-0001 | 2007-05-24 |
| 1427266931 | Brian Michael Strahl | Military Health Care Provider | 5 Nmcb 5 Street, Port Hueneme, CA 93041 | 2007-05-18 |
| Find all providers in PORT HUENEME | ||||
| City | PORT HUENEME |
| Zip Code | 93043 |
Please comment or provide details below to improve the information on SHAYNE TYLER STANLEY.
| 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.