Provider Demographics
NPI:1346051893
Name:JACOBS, SHAYLA ALISE
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:ALISE
Last Name:JACOBS
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 1:2291 NW 48TH TER APT 102
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3419
Mailing Address - Country:US
Mailing Address - Phone:704-651-2635
Mailing Address - Fax:
Practice Address - Street 1:2291 NW 48TH TER APT 102
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-3419
Practice Address - Country:US
Practice Address - Phone:704-651-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach