Provider Demographics
NPI:1497518948
Name:MCCOY, SHAUNTAYE
Entity Type:Individual
Prefix:
First Name:SHAUNTAYE
Middle Name:
Last Name:MCCOY
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 1:50208 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:OH
Mailing Address - Zip Code:45771-7527
Mailing Address - Country:US
Mailing Address - Phone:937-238-0346
Mailing Address - Fax:
Practice Address - Street 1:50208 HARVEST LN
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:OH
Practice Address - Zip Code:45771-7527
Practice Address - Country:US
Practice Address - Phone:193-723-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide