Provider Demographics
NPI:1023364940
Name:BOYD, SHIVONNE W
Entity Type:Individual
Prefix:
First Name:SHIVONNE
Middle Name:W
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 GILMERTON RD
Mailing Address - Street 2:114E
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-4923
Mailing Address - Country:US
Mailing Address - Phone:843-469-9269
Mailing Address - Fax:
Practice Address - Street 1:2516 GILMERTON RD
Practice Address - Street 2:114E
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-4923
Practice Address - Country:US
Practice Address - Phone:757-215-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA910765374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide