Provider Demographics
NPI:1326763442
Name:SHY, KATEKA R
Entity Type:Individual
Prefix:
First Name:KATEKA
Middle Name:R
Last Name:SHY
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 1:990 FREDERICK BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2647
Mailing Address - Country:US
Mailing Address - Phone:330-606-1433
Mailing Address - Fax:
Practice Address - Street 1:990 FREDERICK BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2647
Practice Address - Country:US
Practice Address - Phone:330-606-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No342000000XTransportation ServicesTransportation Network Company