Provider Demographics
NPI:1518797885
Name:TYSON, SHEKAIL (PHLEBOTOMY)
Entity type:Individual
Prefix:
First Name:SHEKAIL
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:PHLEBOTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4783
Mailing Address - Country:US
Mailing Address - Phone:219-378-0483
Mailing Address - Fax:
Practice Address - Street 1:2002 E 62ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2310
Practice Address - Country:US
Practice Address - Phone:219-378-0483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24R-1941246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy