Healthcare Provider Details

I. General information

NPI: 1730315573
Provider Name (Legal Business Name): MISS SHEILA FAITH FRYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 MARYLAND ST
ABERDEEN OH
45101-9749
US

IV. Provider business mailing address

PO BOX 318 1159 MARYLAND ST
ABERDEEN OH
45101-0318
US

V. Phone/Fax

Practice location:
  • Phone: 937-795-2114
  • Fax:
Mailing address:
  • Phone: 937-795-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number2929031
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: