Healthcare Provider Details

I. General information

NPI: 1649180605
Provider Name (Legal Business Name): SHELBY GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S HAMILTON RD
GAHANNA OH
43230-2919
US

IV. Provider business mailing address

140 S HAMILTON RD
GAHANNA OH
43230-2919
US

V. Phone/Fax

Practice location:
  • Phone: 614-478-5579
  • Fax: 614-453-8557
Mailing address:
  • Phone: 614-478-5579
  • Fax: 614-453-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number.444893
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: