Provider Demographics
NPI:1194434910
Name:COY, SHAYNA ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:ELAINE
Last Name:COY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 OPECHEE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-1438
Mailing Address - Country:US
Mailing Address - Phone:260-452-6852
Mailing Address - Fax:
Practice Address - Street 1:205 TOWER DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:IN
Practice Address - Zip Code:46772-9362
Practice Address - Country:US
Practice Address - Phone:260-692-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003797A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant