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NPI Code Detail

MEDICARE: SHAY GREENWALT

MEDICARE: SHAY GREENWALT
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1750849915
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAY GREENWALT
Provider Business Mailing Address
First Line : 449 E NORTHWOOD AVE APT D
Second Line :
City : COLUMBUS
State : OH
Zip : 43201-1369
Country : US
Telephone Number : 740-701-1592
Fax Number :
Provider Business Practice Location Address
First Line : 774 INTERNET DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-2589
Country : US
Telephone Number : 614-443-5454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2019
Last Update Date : 03/06/2019

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Directions to “ SHAY GREENWALT ” Practice Location

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