Provider Demographics
NPI:1700249638
Name:CUMMINGS, SHYLA
Entity Type:Individual
Prefix:
First Name:SHYLA
Middle Name:
Last Name:CUMMINGS
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:W7210 CO P
Mailing Address - Street 2:
Mailing Address - City:ENDEAVOR
Mailing Address - State:WI
Mailing Address - Zip Code:53930
Mailing Address - Country:US
Mailing Address - Phone:608-617-5032
Mailing Address - Fax:
Practice Address - Street 1:W7210 COUNTY P
Practice Address - Street 2:
Practice Address - City:ENDEAVOR
Practice Address - State:WI
Practice Address - Zip Code:53930
Practice Address - Country:US
Practice Address - Phone:608-617-5032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer