Provider Demographics
NPI:1093116444
Name:WALSTON, SHAYLA (LPN)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:WALSTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 WALZ DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5833
Mailing Address - Country:US
Mailing Address - Phone:757-329-5554
Mailing Address - Fax:
Practice Address - Street 1:230 DUNCAN DR
Practice Address - Street 2:BLDG 1440
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-5107
Practice Address - Country:US
Practice Address - Phone:912-315-6500
Practice Address - Fax:912-315-5870
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002083028164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse