Provider Demographics
NPI:1841605169
Name:DASCHLE, SHAYLA CHRISTINE (APRN, CNM, MSN)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:CHRISTINE
Last Name:DASCHLE
Suffix:
Gender:F
Credentials:APRN, CNM, MSN
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:CHRISTINE
Other - Last Name:LEWIS, IRISH, WOOD, BISOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13328 LITTLE GEM CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7914
Mailing Address - Country:US
Mailing Address - Phone:605-219-6530
Mailing Address - Fax:
Practice Address - Street 1:13328 LITTLE GEM CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-7914
Practice Address - Country:US
Practice Address - Phone:605-219-6530
Practice Address - Fax:239-479-5194
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004132367A00000X
MTNUR-RN-LIC-37872367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105170000Medicaid
FLL5352OtherMEDICARE