Provider Demographics
NPI:1730798026
Name:MANIS, SHELVIA JEAN
Entity type:Individual
Prefix:
First Name:SHELVIA
Middle Name:JEAN
Last Name:MANIS
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 1:106 BUFFALO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9642
Mailing Address - Country:US
Mailing Address - Phone:304-690-3844
Mailing Address - Fax:
Practice Address - Street 1:106 BUFFALO CREEK RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9642
Practice Address - Country:US
Practice Address - Phone:304-690-3844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV044405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse