Provider Demographics
NPI:1427418292
Name:LYM, SHAYNA
Entity Type:Individual
Prefix:MISS
First Name:SHAYNA
Middle Name:
Last Name:LYM
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 1:324 LANTANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1510
Mailing Address - Country:US
Mailing Address - Phone:201-569-2424
Mailing Address - Fax:201-569-2433
Practice Address - Street 1:324 LANTANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1510
Practice Address - Country:US
Practice Address - Phone:201-569-2424
Practice Address - Fax:201-569-2433
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health