MEDICARE: DOMINIQUE SHY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN432341	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0030516	OH

General Provider Information

NPI Number	:	1144766676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE SHY NP

Provider Business Mailing Address
First Line	:	1326 WINSTON RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2516
Country	:	US
Telephone Number	:	216-324-9879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 WINSTON RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2516
Country	:	US
Telephone Number	:	216-324-9879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2017
Last Update Date	:	12/01/2025

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