Healthcare Provider Details

I. General information

NPI: 1205329547
Provider Name (Legal Business Name): RACHAEL NICOLE SPADY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE SPADY ROBERTS MD

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 PENTAGON BLVD STE 220
BEAVERCREEK OH
45431-1705
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-429-7350
  • Fax: 937-431-2623
Mailing address:
  • Phone: 937-762-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.146392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: