Provider Demographics
NPI:1518370303
Name:ALLEN, SHYLANDER (LVN)
Entity Type:Individual
Prefix:
First Name:SHYLANDER
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56590 EL DORADO DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-4233
Mailing Address - Country:US
Mailing Address - Phone:562-688-7228
Mailing Address - Fax:
Practice Address - Street 1:56590 EL DORADO DR
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-4233
Practice Address - Country:US
Practice Address - Phone:562-688-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN232514164X00000X
CA232514164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse