Provider Demographics
NPI:1699362749
Name:SHIVADECKER, CINDY EVALINE
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:EVALINE
Last Name:SHIVADECKER
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 1:5718 S UNION RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-1334
Mailing Address - Country:US
Mailing Address - Phone:937-776-4823
Mailing Address - Fax:
Practice Address - Street 1:5718 S UNION RD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-1334
Practice Address - Country:US
Practice Address - Phone:937-902-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant