Provider Demographics
NPI:1144917576
Name:LYONS, SHADAE MARY
Entity type:Individual
Prefix:MRS
First Name:SHADAE
Middle Name:MARY
Last Name:LYONS
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 1:1115 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-5101
Mailing Address - Country:US
Mailing Address - Phone:513-628-9408
Mailing Address - Fax:
Practice Address - Street 1:1115 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-5101
Practice Address - Country:US
Practice Address - Phone:513-628-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty