Provider Demographics
NPI:1861256018
Name:TYSON, SHELLY LYNN
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:LYNN
Last Name:TYSON
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 1:16092 FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8008
Mailing Address - Country:US
Mailing Address - Phone:419-348-1092
Mailing Address - Fax:
Practice Address - Street 1:16092 FOREST LAKE DR
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8008
Practice Address - Country:US
Practice Address - Phone:419-348-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide