Provider Demographics
NPI:1750849915
Name:GREENWALT, SHAY
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:
Last Name:GREENWALT
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 1:449 E NORTHWOOD AVE APT D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-1369
Mailing Address - Country:US
Mailing Address - Phone:740-701-1592
Mailing Address - Fax:
Practice Address - Street 1:774 INTERNET DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2589
Practice Address - Country:US
Practice Address - Phone:614-443-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator