Provider Demographics
NPI:1457644544
Name:LOYOLA, SHIELA EDAYA (SHIELA)
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:EDAYA
Last Name:LOYOLA
Suffix:
Gender:F
Credentials:SHIELA
Other - Prefix:
Other - First Name:SHIELA
Other - Middle Name:EDAYA
Other - Last Name:LOYOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SHIELA
Mailing Address - Street 1:1100 W JEFFERY ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-4680
Mailing Address - Country:US
Mailing Address - Phone:309-278-2874
Mailing Address - Fax:
Practice Address - Street 1:1100 W JEFFERY ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-4680
Practice Address - Country:US
Practice Address - Phone:309-278-2874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017759314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility