Provider Demographics
NPI:1407460280
Name:NIX, SHIYLA ANN (PEER SUPPORT)
Entity Type:Individual
Prefix:
First Name:SHIYLA
Middle Name:ANN
Last Name:NIX
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6362
Mailing Address - Country:US
Mailing Address - Phone:216-392-9994
Mailing Address - Fax:
Practice Address - Street 1:3885 WARRENSVILLE RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6362
Practice Address - Country:US
Practice Address - Phone:216-392-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0001699175T00000X
OH354879163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No175T00000XOther Service ProvidersPeer Specialist