Provider Demographics
NPI:1386198851
Name:SHANKLE, DYRAL KEITH
Entity Type:Individual
Prefix:
First Name:DYRAL
Middle Name:KEITH
Last Name:SHANKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-6515
Mailing Address - Country:US
Mailing Address - Phone:704-465-1470
Mailing Address - Fax:
Practice Address - Street 1:402 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2013
Practice Address - Country:US
Practice Address - Phone:704-294-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes376K00000XNursing Service Related ProvidersNurse's Aide