Provider Demographics
NPI:1669154613
Name:GIBSON, SHONTAYSHAY DABREE
Entity type:Individual
Prefix:MS
First Name:SHONTAYSHAY
Middle Name:DABREE
Last Name:GIBSON
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 1:424 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1714
Mailing Address - Country:US
Mailing Address - Phone:234-855-5224
Mailing Address - Fax:
Practice Address - Street 1:424 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1714
Practice Address - Country:US
Practice Address - Phone:234-855-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker