MEDICARE: SHELLESSA DIANA DILLARD

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	172A00000X	Driver	RR643232	OH

General Provider Information

NPI Number	:	1578416343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLESSA DIANA DILLARD

Provider Business Mailing Address
First Line	:	1604 OAKRIDGE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-2419
Country	:	US
Telephone Number	:	937-520-6799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 OAKRIDGE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-2419
Country	:	US
Telephone Number	:	937-520-6799
Fax Number	:

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

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	02/19/2026

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Directions to “ SHELLESSA DIANA DILLARD ” Practice Location

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