Provider Demographics
NPI:1992350698
Name:SHANDS, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SHANDS
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 1:6230 LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-3416
Mailing Address - Country:US
Mailing Address - Phone:215-409-5122
Mailing Address - Fax:
Practice Address - Street 1:6230 LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19142-3416
Practice Address - Country:US
Practice Address - Phone:215-409-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA21734341Medicaid