Provider Demographics
NPI:1902601313
Name:CORDOVA, SHAYLA MARIE
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:MARIE
Last Name:CORDOVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9237
Mailing Address - Country:US
Mailing Address - Phone:402-480-4352
Mailing Address - Fax:
Practice Address - Street 1:10311 N 142ND ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-1407
Practice Address - Country:US
Practice Address - Phone:402-480-4352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion