Provider Demographics
NPI:1790382752
Name:SHINE, KEYONA (RN)
Entity type:Individual
Prefix:
First Name:KEYONA
Middle Name:
Last Name:SHINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2101 SILVER MAPLE WAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2380
Mailing Address - Country:US
Mailing Address - Phone:440-830-3400
Mailing Address - Fax:440-830-3417
Practice Address - Street 1:2101 SILVER MAPLE WAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2380
Practice Address - Country:US
Practice Address - Phone:440-830-3400
Practice Address - Fax:440-830-3417
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.436004163W00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0419972Medicaid