Provider Demographics
NPI:1467112201
Name:SHADE, QIANA R
Entity Type:Individual
Prefix:MRS
First Name:QIANA
Middle Name:R
Last Name:SHADE
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 1:434 KOERBER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3739
Mailing Address - Country:US
Mailing Address - Phone:330-689-8966
Mailing Address - Fax:
Practice Address - Street 1:434 KOERBER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-3739
Practice Address - Country:US
Practice Address - Phone:330-689-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)