Provider Demographics
NPI:1811554876
Name:PHEGLEY, SHAYNA LEIGH (NP)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:LEIGH
Last Name:PHEGLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:118 W DREXEL PKWY
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-7344
Practice Address - Country:US
Practice Address - Phone:219-866-4300
Practice Address - Fax:219-866-7591
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2023-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28195032A163W00000X
IN71009070A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28195032AOtherLICENSE