Provider Demographics
NPI:1235967456
Name:PICKELL, SHAYNA ANN
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:ANN
Last Name:PICKELL
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 1:2111 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3826
Mailing Address - Country:US
Mailing Address - Phone:712-291-1811
Mailing Address - Fax:
Practice Address - Street 1:2111 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3826
Practice Address - Country:US
Practice Address - Phone:712-291-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide