Healthcare Provider Details

I. General information

NPI: 1619883295
Provider Name (Legal Business Name): SHYANNE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MADISON AVE SUITE 200
TOLEDO OH
43604
US

IV. Provider business mailing address

1405 GIBBARD AVE
COLUMBUS OH
43219-2442
US

V. Phone/Fax

Practice location:
  • Phone: 567-312-8700
  • Fax: 567-312-8793
Mailing address:
  • Phone: 937-541-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: