Provider Demographics
NPI:1093200321
Name:SHEY, ODETTE NIANH
Entity Type:Individual
Prefix:
First Name:ODETTE
Middle Name:NIANH
Last Name:SHEY
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 1:1836 METZEROTT RD APT 1103
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3448
Mailing Address - Country:US
Mailing Address - Phone:240-423-7281
Mailing Address - Fax:
Practice Address - Street 1:1836 METZEROTT RD APT 1103
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3448
Practice Address - Country:US
Practice Address - Phone:240-423-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13718374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide