Provider Demographics
NPI:1033963376
Name:STATEN, SHAYLA MONAE
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:MONAE
Last Name:STATEN
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 1:4524 MERRYGOLD BLVD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5037
Mailing Address - Country:US
Mailing Address - Phone:216-758-0614
Mailing Address - Fax:
Practice Address - Street 1:4524 MERRYGOLD BLVD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5037
Practice Address - Country:US
Practice Address - Phone:216-758-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion