Healthcare Provider Details

I. General information

NPI: 1386653756
Provider Name (Legal Business Name): SHAUNA LOUISE REED PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7677 YANKEE ST STE 140
CENTERVILLE OH
45459-3475
US

IV. Provider business mailing address

7677 YANKEE ST STE 140
CENTERVILLE OH
45459-3475
US

V. Phone/Fax

Practice location:
  • Phone: 937-454-9527
  • Fax: 937-454-9532
Mailing address:
  • Phone: 937-454-9527
  • Fax: 937-454-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50001856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: