Provider Demographics
NPI:1336506401
Name:EVANS, SHAYLA VICTORIA
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:VICTORIA
Last Name:EVANS
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 1:1155 REID AVE
Mailing Address - Street 2:APT C
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3462
Mailing Address - Country:US
Mailing Address - Phone:440-989-0276
Mailing Address - Fax:
Practice Address - Street 1:1155 REID AVE
Practice Address - Street 2:APT C
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3462
Practice Address - Country:US
Practice Address - Phone:440-989-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401469971212376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide