Provider Demographics
NPI:1669796876
Name:SHAYA, LIANE ALEXIS (LMP)
Entity type:Individual
Prefix:MS
First Name:LIANE
Middle Name:ALEXIS
Last Name:SHAYA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24435 GOOSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BLOOMINGVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43152-9750
Mailing Address - Country:US
Mailing Address - Phone:614-506-2221
Mailing Address - Fax:
Practice Address - Street 1:24435 GOOSE CREEK RD
Practice Address - Street 2:
Practice Address - City:SOUTH BLOOMINGVILLE
Practice Address - State:OH
Practice Address - Zip Code:43152-9750
Practice Address - Country:US
Practice Address - Phone:614-506-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60130228225700000X
OH33.017667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist