Provider Demographics
NPI:1750998506
Name:AYALA, SHYNALEE NATIVIDAD
Entity type:Individual
Prefix:
First Name:SHYNALEE
Middle Name:NATIVIDAD
Last Name:AYALA
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 1:410 WESLEY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2328
Mailing Address - Country:US
Mailing Address - Phone:678-595-4004
Mailing Address - Fax:
Practice Address - Street 1:410 WESLEY CLUB DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-2328
Practice Address - Country:US
Practice Address - Phone:678-595-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030053438374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide