Provider Demographics
NPI:1104301357
Name:MOULTON, SHAYNA NALEDI
Entity type:Individual
Prefix:MISS
First Name:SHAYNA
Middle Name:NALEDI
Last Name:MOULTON
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 1:8201 RETREAT CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7340
Mailing Address - Country:US
Mailing Address - Phone:334-649-9434
Mailing Address - Fax:
Practice Address - Street 1:333 BUSINESS CIR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1778
Practice Address - Country:US
Practice Address - Phone:205-255-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-1535022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry