Healthcare Provider Details

I. General information

NPI: 1770988826
Provider Name (Legal Business Name): SHYRA FAY MERILA M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N HIGHWAY 101 SUITE 204
WARRENTON OR
97146-9371
US

IV. Provider business mailing address

65 N HIGHWAY 101 SUITE 204
WARRENTON OR
97146-9371
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-0241
  • Fax:
Mailing address:
  • Phone: 503-325-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: