Provider Demographics
NPI:1528305273
Name:HAYES, SHIAWANA A
Entity type:Individual
Prefix:MS
First Name:SHIAWANA
Middle Name:A
Last Name:HAYES
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 1:2119 RED OAK CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-2668
Mailing Address - Country:US
Mailing Address - Phone:209-373-9109
Mailing Address - Fax:
Practice Address - Street 1:2119 RED OAK CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-2668
Practice Address - Country:US
Practice Address - Phone:209-373-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator