Provider Demographics
NPI:1053094763
Name:ANDREWS, SHANEL TYNISHA
Entity type:Individual
Prefix:
First Name:SHANEL
Middle Name:TYNISHA
Last Name:ANDREWS
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 1:1924 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3136
Mailing Address - Country:US
Mailing Address - Phone:701-642-2060
Mailing Address - Fax:
Practice Address - Street 1:1924 WALNUT CT
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3136
Practice Address - Country:US
Practice Address - Phone:701-642-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant