Healthcare Provider Details

I. General information

NPI: 1669898854
Provider Name (Legal Business Name): SHAYLA MOONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 GOLDEN CREST CIR
BIRMINGHAM AL
35209-1104
US

IV. Provider business mailing address

216 GOLDEN CREST CIR
BIRMINGHAM AL
35209-1104
US

V. Phone/Fax

Practice location:
  • Phone: 334-201-3251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number3520
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: