Provider Demographics
NPI:1851883532
Name:YAI, SHIMELES
Entity Type:Individual
Prefix:
First Name:SHIMELES
Middle Name:
Last Name:YAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 57TH PL NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5422
Mailing Address - Country:US
Mailing Address - Phone:612-701-4956
Mailing Address - Fax:
Practice Address - Street 1:131 57TH PL NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5422
Practice Address - Country:US
Practice Address - Phone:612-701-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)