Provider Demographics
NPI:1093574113
Name:SHACKLE, TARYN RENEE
Entity Type:Individual
Prefix:MISS
First Name:TARYN
Middle Name:RENEE
Last Name:SHACKLE
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 1:463 MOHICAN ST NE
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44613
Mailing Address - Country:US
Mailing Address - Phone:330-312-2307
Mailing Address - Fax:
Practice Address - Street 1:463 MOHICAN ST NE
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:OH
Practice Address - Zip Code:44613
Practice Address - Country:US
Practice Address - Phone:330-312-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide