Provider Demographics
NPI:1245923929
Name:TANKING, SHAY
Entity type:Individual
Prefix:
First Name:SHAY
Middle Name:
Last Name:TANKING
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 1:25850 L RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66416-9616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25850 L RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66416-9616
Practice Address - Country:US
Practice Address - Phone:785-851-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer