Healthcare Provider Details

I. General information

NPI: 1073871604
Provider Name (Legal Business Name): SHANNON RAESHELL SEALS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 STETSON ST STE 2300
CINCINNATI OH
45219-2450
US

IV. Provider business mailing address

260 STETSON ST STE 2300
CINCINNATI OH
45219-2450
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7964
  • Fax:
Mailing address:
  • Phone: 513-558-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD176308
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number307344
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: