Provider Demographics
NPI:1417667007
Name:HOLLOWAY, SHAKAHNA (STNA)
Entity Type:Individual
Prefix:
First Name:SHAKAHNA
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15421 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1944
Mailing Address - Country:US
Mailing Address - Phone:440-694-9867
Mailing Address - Fax:
Practice Address - Street 1:15421 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1944
Practice Address - Country:US
Practice Address - Phone:440-694-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH601835921022376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator