Provider Demographics
NPI:1902686850
Name:SHANMUGAM, JAYLA KAY
Entity Type:Individual
Prefix:
First Name:JAYLA
Middle Name:KAY
Last Name:SHANMUGAM
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 1:2348 STONELICK CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8113
Mailing Address - Country:US
Mailing Address - Phone:614-397-3715
Mailing Address - Fax:
Practice Address - Street 1:7938 TARTAN FIELDS DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8770
Practice Address - Country:US
Practice Address - Phone:614-397-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant