Provider Demographics
NPI:1790068286
Name:SHYES, TANYA R (LMT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:R
Last Name:SHYES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2965
Mailing Address - Country:US
Mailing Address - Phone:931-982-4169
Mailing Address - Fax:
Practice Address - Street 1:1524 PATRICK DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2965
Practice Address - Country:US
Practice Address - Phone:931-982-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9170174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist