Provider Demographics
NPI:1952927774
Name:RICHIE, SHALY
Entity Type:Individual
Prefix:
First Name:SHALY
Middle Name:
Last Name:RICHIE
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 1:3946 W EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-4626
Mailing Address - Country:US
Mailing Address - Phone:480-547-7837
Mailing Address - Fax:
Practice Address - Street 1:3946 W EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-4626
Practice Address - Country:US
Practice Address - Phone:480-547-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health