Provider Demographics
NPI:1336934330
Name:GRAHAM, SHAE-LYNN
Entity type:Individual
Prefix:
First Name:SHAE-LYNN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7423 TIFFANY BLVD S
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3908
Mailing Address - Country:US
Mailing Address - Phone:330-629-2955
Mailing Address - Fax:
Practice Address - Street 1:7423 TIFFANY BLVD S
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3908
Practice Address - Country:US
Practice Address - Phone:330-629-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician