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NPI Code Detail

MEDICARE: SHAELYN KOVALYOV LVN

MEDICARE:   SHAELYN  KOVALYOV  LVN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse348303TX

General Provider Information

NPI Number : 1265099931
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAELYN KOVALYOV LVN
Provider Business Mailing Address
First Line : 11227 JADE HTS
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-5024
Country : US
Telephone Number : 443-514-6135
Fax Number :
Provider Business Practice Location Address
First Line : 11227 JADE HTS
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-5024
Country : US
Telephone Number : 443-514-6135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2019
Last Update Date : 05/28/2019

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Directions to “ SHAELYN KOVALYOV LVN” Practice Location

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