Provider Demographics
NPI:1912209677
Name:LONG PEEPLES, SHAMYRA (RN)
Entity Type:Individual
Prefix:
First Name:SHAMYRA
Middle Name:
Last Name:LONG PEEPLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHAMYRA
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:285 W STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3889
Mailing Address - Country:US
Mailing Address - Phone:216-799-5177
Mailing Address - Fax:
Practice Address - Street 1:285 W STURBRIDGE DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3889
Practice Address - Country:US
Practice Address - Phone:216-799-5177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 346122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse