Provider Demographics
NPI:1164637161
Name:SHAYNA YEDRA-SCHAEFER
Entity Type:Organization
Organization Name:SHAYNA YEDRA-SCHAEFER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAYNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-720-7702
Mailing Address - Street 1:1717 WILMOORE DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4128
Mailing Address - Country:US
Mailing Address - Phone:505-720-7702
Mailing Address - Fax:
Practice Address - Street 1:1717 WILMOORE DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4128
Practice Address - Country:US
Practice Address - Phone:505-720-7702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-060021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10021694OtherLOVELACE
NM73726851Medicaid
NM73726851Medicaid