Shantwana S Lyles

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

KK546154 Issued in CA

Practice address

2807 Forest Hollow LN Apt 3313
Arlington, TX 76006-3020

Phone

(909) 485-2273

NPI assigned

May 10, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shantwana S Lyles Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525910400000",
    "number": "1770073231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2807 FOREST HOLLOW LN APT 3313",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760063020",
            "telephone_number": "909-485-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2807 FOREST HOLLOW LN APT 3313",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760063020",
            "telephone_number": "909-485-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYLES",
        "first_name": "SHANTWANA",
        "middle_name": "S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-10",
        "last_updated": "2018-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "CA",
            "license": "KK546154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANTWANA",
            "last_name": "LYLES",
            "middle_name": "S",
            "credential": "SHANTWANA S LYLES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Prosthetist in Arlington, TX
• Providers in Arlington, TX by specialty
• Prosthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.