Provider Demographics
NPI:1891565362
Name:YODER, SHAWNIECE
Entity Type:Individual
Prefix:
First Name:SHAWNIECE
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNIECE
Other - Middle Name:
Other - Last Name:DHYLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6247 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4138
Mailing Address - Country:US
Mailing Address - Phone:216-333-9820
Mailing Address - Fax:
Practice Address - Street 1:6247 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4138
Practice Address - Country:US
Practice Address - Phone:216-333-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant