Provider Demographics
NPI:1770239329
Name:CRAVENS, SHAYLA
Entity Type:Individual
Prefix:MS
First Name:SHAYLA
Middle Name:
Last Name:CRAVENS
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 1:3505 CHAPEL LN
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9415
Mailing Address - Country:US
Mailing Address - Phone:502-554-2693
Mailing Address - Fax:
Practice Address - Street 1:3505 CHAPEL LN
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9415
Practice Address - Country:US
Practice Address - Phone:502-554-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist