Provider Demographics
NPI:1396005526
Name:SHAYO, THERESIA HAIKA
Entity Type:Individual
Prefix:
First Name:THERESIA
Middle Name:HAIKA
Last Name:SHAYO
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 1:11359 COLUMBIA PIKE
Mailing Address - Street 2:APT D8
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2512
Mailing Address - Country:US
Mailing Address - Phone:240-413-5303
Mailing Address - Fax:
Practice Address - Street 1:11359 COLUMBIA PIKE
Practice Address - Street 2:APT D8
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2512
Practice Address - Country:US
Practice Address - Phone:240-413-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS000792292298477374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide