Provider Demographics
NPI:1699898767
Name:SHANAYDA, LISA JANE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JANE
Last Name:SHANAYDA
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 1:808 E COOPER RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-9453
Mailing Address - Country:US
Mailing Address - Phone:765-730-1203
Mailing Address - Fax:
Practice Address - Street 1:808 E COOPER RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-9453
Practice Address - Country:US
Practice Address - Phone:765-730-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist