Provider Demographics
NPI:1821703828
Name:HORN, SHALIYAH RENEE
Entity Type:Individual
Prefix:
First Name:SHALIYAH
Middle Name:RENEE
Last Name:HORN
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 1:5824 MILLSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4164
Mailing Address - Country:US
Mailing Address - Phone:937-559-7395
Mailing Address - Fax:
Practice Address - Street 1:5824 MILLSHIRE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-4164
Practice Address - Country:US
Practice Address - Phone:937-559-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUT266306374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide