Healthcare Provider Details

I. General information

NPI: 1780081224
Provider Name (Legal Business Name): SHELBY GONSALES APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY MCQUOWN

II. Dates (important events)

Enumeration Date: 11/27/2014
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date: 04/20/2015
Reactivation Date: 01/26/2021

III. Provider practice location address

430 ARLINGTON RD STE
BROOKVILLE OH
45309-1103
US

IV. Provider business mailing address

4300 TOLL GATE LN
BELLBROOK OH
45305-1235
US

V. Phone/Fax

Practice location:
  • Phone: 326-699-6100
  • Fax:
Mailing address:
  • Phone: 937-867-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0028190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: