Healthcare Provider Details

I. General information

NPI: 1285791467
Provider Name (Legal Business Name): SHELLEY MARIE BARNEY PA-C,MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450B WASHINGTON JACKSON RD STE 108
EATON OH
45320-7601
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-456-8330
  • Fax: 937-456-8335
Mailing address:
  • Phone: 937-456-8330
  • Fax: 937-456-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001597RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.001597
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: