Provider Demographics
NPI:1417795691
Name:DEANE, SHAYLYN GRACE
Entity type:Individual
Prefix:
First Name:SHAYLYN
Middle Name:GRACE
Last Name:DEANE
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 1:1906 E BROADWAY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4740
Mailing Address - Country:US
Mailing Address - Phone:701-415-6233
Mailing Address - Fax:
Practice Address - Street 1:11 4TH ST SE # 2
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5651
Practice Address - Country:US
Practice Address - Phone:701-312-9357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator