Provider Demographics
NPI:1558631978
Name:TOLIVER, SHANAIA TENAYE (CNA)
Entity Type:Individual
Prefix:MS
First Name:SHANAIA
Middle Name:TENAYE
Last Name:TOLIVER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6931
Mailing Address - Country:US
Mailing Address - Phone:410-585-8669
Mailing Address - Fax:
Practice Address - Street 1:3212 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-6931
Practice Address - Country:US
Practice Address - Phone:410-585-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00065747374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide