Provider Demographics
NPI:1093302366
Name:SCOVIL, SHANIYA
Entity Type:Individual
Prefix:
First Name:SHANIYA
Middle Name:
Last Name:SCOVIL
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 1:3860 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1104
Mailing Address - Country:US
Mailing Address - Phone:216-798-3521
Mailing Address - Fax:
Practice Address - Street 1:3860 E 149TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1104
Practice Address - Country:US
Practice Address - Phone:216-450-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1831722376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker