Provider Demographics
NPI:1477130532
Name:RUBI, SHAYNA RENE
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:RENE
Last Name:RUBI
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 1:4748 LIBERTY RD S APT 208
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5189
Mailing Address - Country:US
Mailing Address - Phone:520-833-8810
Mailing Address - Fax:
Practice Address - Street 1:1655 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7845
Practice Address - Country:US
Practice Address - Phone:503-877-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000104705374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000104705Medicaid