Provider Demographics
NPI:1174357230
Name:CANADA, SHYANN NICOLE
Entity type:Individual
Prefix:
First Name:SHYANN
Middle Name:NICOLE
Last Name:CANADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MAURICE ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:WV
Mailing Address - Zip Code:24898
Mailing Address - Country:US
Mailing Address - Phone:304-890-7004
Mailing Address - Fax:
Practice Address - Street 1:62 MAURICE ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:WV
Practice Address - Zip Code:24898
Practice Address - Country:US
Practice Address - Phone:304-890-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant