Provider Demographics
NPI:1275159485
Name:AGUILAR, SHAYNA LEEANN (NP)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:LEEANN
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:
Other - Last Name:ECKOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4618 WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:IN
Mailing Address - Zip Code:46118-9096
Mailing Address - Country:US
Mailing Address - Phone:317-850-8426
Mailing Address - Fax:
Practice Address - Street 1:239 HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1340
Practice Address - Country:US
Practice Address - Phone:765-653-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010532A363LP0808X
IN71010532363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health