Provider Demographics
NPI:1831853100
Name:SHAYNE, AMYLIA MAY (DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:AMYLIA
Middle Name:MAY
Last Name:SHAYNE
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 S OSTRUM AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8694
Mailing Address - Country:US
Mailing Address - Phone:206-383-9762
Mailing Address - Fax:
Practice Address - Street 1:100 W MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7362
Practice Address - Country:US
Practice Address - Phone:208-495-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61221885207Q00000X, 363LF0000X
ID75473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health