Provider Demographics
NPI:1184072340
Name:SHURILLA, LYNDA
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:SHURILLA
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 1:59 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1812
Mailing Address - Country:US
Mailing Address - Phone:330-755-2262
Mailing Address - Fax:
Practice Address - Street 1:59 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1812
Practice Address - Country:US
Practice Address - Phone:330-755-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2016-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN128979163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)