MEDICARE: SHANDA A APPLEBERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1336945690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANDA A APPLEBERRY

Provider Business Mailing Address
First Line	:	1914 NEEDMORE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3808
Country	:	US
Telephone Number	:	937-313-9764
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 NEEDMORE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3808
Country	:	US
Telephone Number	:	937-313-9764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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Directions to “ SHANDA A APPLEBERRY ” Practice Location

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