Healthcare Provider Details

I. General information

NPI: 1073425690
Provider Name (Legal Business Name): SHAYLAH NICHOLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 LOMITA ST
MONTEREY CA
93940-4433
US

IV. Provider business mailing address

1603 CAPITOL AVE STE 413
CHEYENNE WY
82001-4562
US

V. Phone/Fax

Practice location:
  • Phone: 862-239-5672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHAYLAH LEE
Title or Position: OWNER
Credential: LCSW
Phone: 862-239-5672