Healthcare Provider Details

I. General information

NPI: 1114411055
Provider Name (Legal Business Name): SHAYNA MARSHALL BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6279 FRANK AVE NW
CANTON OH
44720-7227
US

IV. Provider business mailing address

6279 FRANK AVE NW
CANTON OH
44720-7227
US

V. Phone/Fax

Practice location:
  • Phone: 330-305-1668
  • Fax:
Mailing address:
  • Phone: 330-305-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: