Provider Demographics
NPI:1740933597
Name:RICHARDS, SHAYNA (FNP)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4001
Mailing Address - Country:US
Mailing Address - Phone:971-704-5382
Mailing Address - Fax:971-385-4153
Practice Address - Street 1:329 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4001
Practice Address - Country:US
Practice Address - Phone:971-704-5382
Practice Address - Fax:971-385-4153
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10012569363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner