Healthcare Provider Details

I. General information

NPI: 1366793366
Provider Name (Legal Business Name): MRS. SHALON CAROLYN WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHALON CAROLYN SAYRE RN

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CHELSEA AVE
DAYTON OH
45420-3064
US

IV. Provider business mailing address

2611 WAYNE AVE
DAYTON OH
45420-1833
US

V. Phone/Fax

Practice location:
  • Phone: 937-422-7082
  • Fax:
Mailing address:
  • Phone: 937-641-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN397751
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: