Provider Demographics
NPI:1144766676
Name:SHY, DOMINIQUE (NP)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:SHY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4126 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2739
Mailing Address - Country:US
Mailing Address - Phone:216-324-9879
Mailing Address - Fax:
Practice Address - Street 1:3455 MILL RUN DR STE 310
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9082
Practice Address - Country:US
Practice Address - Phone:833-358-2036
Practice Address - Fax:855-299-2185
Is Sole Proprietor?:No
Enumeration Date:2017-01-08
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN432341163W00000X
OHAPRN.CNP.0030516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse