Healthcare Provider Details

I. General information

NPI: 1770239329
Provider Name (Legal Business Name): MS. SHAYLA CRAVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 CHAPEL LN
NEW ALBANY IN
47150-9415
US

IV. Provider business mailing address

3505 CHAPEL LN
NEW ALBANY IN
47150-9415
US

V. Phone/Fax

Practice location:
  • Phone: 502-554-2693
  • Fax:
Mailing address:
  • Phone: 502-554-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: