Provider Demographics
NPI:1386311777
Name:FLOYD, SHANE K
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:K
Last Name:FLOYD
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 1:33 OAK TREE DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9293
Mailing Address - Country:US
Mailing Address - Phone:330-501-4020
Mailing Address - Fax:
Practice Address - Street 1:33 OAK TREE DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9293
Practice Address - Country:US
Practice Address - Phone:330-501-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor