Provider Demographics
NPI:1730814112
Name:ODOM, TROYNESHIA LA'SHAY
Entity type:Individual
Prefix:
First Name:TROYNESHIA
Middle Name:LA'SHAY
Last Name:ODOM
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 1:686 COUNTY ROAD 260
Mailing Address - Street 2:
Mailing Address - City:SHUBUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39360-9025
Mailing Address - Country:US
Mailing Address - Phone:601-692-5087
Mailing Address - Fax:
Practice Address - Street 1:686 COUNTY ROAD 260
Practice Address - Street 2:
Practice Address - City:SHUBUTA
Practice Address - State:MS
Practice Address - Zip Code:39360-9025
Practice Address - Country:US
Practice Address - Phone:601-692-5087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program