Provider Demographics
NPI:1962012443
Name:TYE, ESSENCE SHANAY
Entity Type:Individual
Prefix:
First Name:ESSENCE
Middle Name:SHANAY
Last Name:TYE
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 1:332 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2151
Mailing Address - Country:US
Mailing Address - Phone:330-389-4681
Mailing Address - Fax:
Practice Address - Street 1:332 GRACE AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2151
Practice Address - Country:US
Practice Address - Phone:330-389-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402056310418376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty