Healthcare Provider Details

I. General information

NPI: 1801213566
Provider Name (Legal Business Name): SHAYLA ENZLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 HOLLY AVE NE SUITE 102B
ALBUQUERQUE NM
87122-2988
US

IV. Provider business mailing address

8100 BARSTOW ST NE APT 7204
ALBUQUERQUE NM
87122-2801
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-1550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: