Provider Demographics
NPI:1689371817
Name:MAYNOR, SHI'ASIA
Entity Type:Individual
Prefix:
First Name:SHI'ASIA
Middle Name:
Last Name:MAYNOR
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 1:3001 JEHOSSEE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5971
Mailing Address - Country:US
Mailing Address - Phone:984-444-0739
Mailing Address - Fax:
Practice Address - Street 1:3001 JEHOSSEE ST APT 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5971
Practice Address - Country:US
Practice Address - Phone:984-444-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program