Healthcare Provider Details

I. General information

NPI: 1043878226
Provider Name (Legal Business Name): YNDIA SHELTON STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 PLAZA AVE NE APT 24
WARREN OH
44483-3558
US

IV. Provider business mailing address

104 JAVIT CT
AUSTINTOWN OH
44515-2439
US

V. Phone/Fax

Practice location:
  • Phone: 330-609-4457
  • Fax:
Mailing address:
  • Phone: 330-797-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number401471641212
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: