Healthcare Provider Details

I. General information

NPI: 1952193005
Provider Name (Legal Business Name): SHANICA ANNIE DYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 FLEMING AVE
LORAIN OH
44055-3927
US

IV. Provider business mailing address

5341 FLEMING AVE
LORAIN OH
44055-3927
US

V. Phone/Fax

Practice location:
  • Phone: 973-747-6725
  • Fax:
Mailing address:
  • Phone: 973-747-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: