Provider Demographics
NPI:1659195287
Name:MATHENY, DANIEL SHANE
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:SHANE
Last Name:MATHENY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WOODBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3333
Mailing Address - Country:US
Mailing Address - Phone:469-473-9764
Mailing Address - Fax:
Practice Address - Street 1:313 WOODBRIDGE RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3333
Practice Address - Country:US
Practice Address - Phone:469-473-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant