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NPI Code Detail

MEDICARE: SHYONA DENISE GAINES

MEDICARE: SHYONA DENISE GAINES
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1689305732
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHYONA DENISE GAINES
Provider Business Mailing Address
First Line : 125 MAY CT
Second Line :
City : NICHOLASVILLE
State : KY
Zip : 40356-2441
Country : US
Telephone Number : 859-354-6980
Fax Number :
Provider Business Practice Location Address
First Line : 2464 FORTUNE DR STE 195
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-4261
Country : US
Telephone Number : 859-899-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2022
Last Update Date : 09/30/2024

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Directions to “ SHYONA DENISE GAINES ” Practice Location

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