Provider Demographics
NPI:1700569159
Name:NICHOLL, SHAYLEE
Entity Type:Individual
Prefix:
First Name:SHAYLEE
Middle Name:
Last Name:NICHOLL
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 1:2415 SNYDER AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1962
Mailing Address - Country:US
Mailing Address - Phone:330-354-5748
Mailing Address - Fax:
Practice Address - Street 1:2415 SNYDER AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1962
Practice Address - Country:US
Practice Address - Phone:330-354-5748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide