Healthcare Provider Details

I. General information

NPI: 1356426639
Provider Name (Legal Business Name): SHELLY J GELONECK P.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY J BIBLE P.A

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR STE 220
CENTERVILLE OH
45459-4094
US

IV. Provider business mailing address

7700 WASHINGTON VILLAGE DR STE 220
CENTERVILLE OH
45459-4094
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-3132
  • Fax: 937-438-0902
Mailing address:
  • Phone: 937-438-3132
  • Fax: 937-438-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number41.5001
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001999
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: