Healthcare Provider Details

I. General information

NPI: 1063133817
Provider Name (Legal Business Name): MS. SHARON MARIE DONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 SQUIRREL RD
DAYTON OH
45405-4444
US

IV. Provider business mailing address

143 SQUIRREL RD
DAYTON OH
45405-4444
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-3240
  • Fax:
Mailing address:
  • Phone: 937-223-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: