Provider Demographics
NPI:1639804867
Name:HAYES, SHANE GREGORY
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:GREGORY
Last Name:HAYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 N MAIN ST APT B
Mailing Address - Street 2:
Mailing Address - City:WEST MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43358-9596
Mailing Address - Country:US
Mailing Address - Phone:740-223-5491
Mailing Address - Fax:
Practice Address - Street 1:139 N MAIN ST APT B
Practice Address - Street 2:
Practice Address - City:WEST MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43358-9596
Practice Address - Country:US
Practice Address - Phone:740-223-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide