Provider Demographics
NPI:1194316117
Name:NEUBERT, SHANE
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:NEUBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-9411
Mailing Address - Country:US
Mailing Address - Phone:304-673-3991
Mailing Address - Fax:
Practice Address - Street 1:227 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CRAB ORCHARD
Practice Address - State:WV
Practice Address - Zip Code:25827-9411
Practice Address - Country:US
Practice Address - Phone:304-673-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant