Provider Demographics
NPI:1821298092
Name:MACCLEARY, SHAYNA
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:MACCLEARY
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 1:2131 SE 10TH AVE
Mailing Address - Street 2:UNIT 1106
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-4511
Mailing Address - Country:US
Mailing Address - Phone:412-736-6926
Mailing Address - Fax:
Practice Address - Street 1:2131 SE 10TH AVE
Practice Address - Street 2:UNIT 1106
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-4511
Practice Address - Country:US
Practice Address - Phone:412-736-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services