Healthcare Provider Details

I. General information

NPI: 1518797885
Provider Name (Legal Business Name): SHEKAIL TYSON PHLEBOTOMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 E 62ND ST
INDIANAPOLIS IN
46220-2310
US

IV. Provider business mailing address

4637 COMMONWEALTH DR
INDIANAPOLIS IN
46220-4783
US

V. Phone/Fax

Practice location:
  • Phone: 219-378-0483
  • Fax:
Mailing address:
  • Phone: 219-378-0483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number24R-1941
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: