Provider Demographics
NPI:1356142459
Name:LYKE, SHENAE D
Entity type:Individual
Prefix:
First Name:SHENAE
Middle Name:D
Last Name:LYKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15288 W EDGEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8990
Mailing Address - Country:US
Mailing Address - Phone:602-772-0714
Mailing Address - Fax:
Practice Address - Street 1:15288 W EDGEMONT AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8990
Practice Address - Country:US
Practice Address - Phone:602-772-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider