Provider Demographics
NPI:1467346031
Name:THEOBALD, SHAYE LILLIAN
Entity type:Individual
Prefix:
First Name:SHAYE
Middle Name:LILLIAN
Last Name:THEOBALD
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 1:5414 MORTENSEN RD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-8488
Mailing Address - Country:US
Mailing Address - Phone:641-903-6465
Mailing Address - Fax:
Practice Address - Street 1:2155 LAGOMARCINO HALL
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010
Practice Address - Country:US
Practice Address - Phone:515-294-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program