Healthcare Provider Details

I. General information

NPI: 1285518266
Provider Name (Legal Business Name): HALEY G SHIARELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HALEY RISINGER

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 LEXINGTON RD STE 110
GEORGETOWN KY
40324-9673
US

IV. Provider business mailing address

404 SHOPPERS DR
WINCHESTER KY
40391-1378
US

V. Phone/Fax

Practice location:
  • Phone: 502-570-3754
  • Fax: 502-570-3756
Mailing address:
  • Phone: 859-737-5333
  • Fax: 859-737-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: