Healthcare Provider Details

I. General information

NPI: 1720421506
Provider Name (Legal Business Name): SHEILA DIANNE KENDALL PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 INDIAN RUN AVE SE
EAST CANTON OH
44730-9748
US

IV. Provider business mailing address

2480 INDIAN RUN AVE SE
EAST CANTON OH
44730-9748
US

V. Phone/Fax

Practice location:
  • Phone: 330-488-2217
  • Fax:
Mailing address:
  • Phone: 330-488-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1000362
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: