MEDICARE: SHANE GREGORY HAYES

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
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1639804867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE GREGORY HAYES

Provider Business Mailing Address
First Line	:	139 N MAIN ST APT B
Second Line	:
City	:	WEST MANSFIELD
State	:	OH
Zip	:	43358-9596
Country	:	US
Telephone Number	:	740-223-5491
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 N MAIN ST APT B
Second Line	:
City	:	WEST MANSFIELD
State	:	OH
Zip	:	43358-9596
Country	:	US
Telephone Number	:	740-223-5491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	07/21/2022

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