Provider Demographics
NPI:1760195788
Name:EDMONDS, SHAKIYLA
Entity Type:Individual
Prefix:
First Name:SHAKIYLA
Middle Name:
Last Name:EDMONDS
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 1:1007 5TH ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-2156
Mailing Address - Country:US
Mailing Address - Phone:412-867-9059
Mailing Address - Fax:
Practice Address - Street 1:1007 5TH ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:PA
Practice Address - Zip Code:15147-2156
Practice Address - Country:US
Practice Address - Phone:412-867-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide