Provider Demographics
NPI:1619619996
Name:BOYD, SHANE TYLER (CRNP)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:TYLER
Last Name:BOYD
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640026
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-0026
Mailing Address - Country:US
Mailing Address - Phone:724-890-5292
Mailing Address - Fax:877-673-3685
Practice Address - Street 1:510 JAMISON AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-2590
Practice Address - Country:US
Practice Address - Phone:724-716-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily