Healthcare Provider Details

I. General information

NPI: 1972703585
Provider Name (Legal Business Name): MS. SHAWYNE M MEDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 07/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BROMTON CT
GAHANNA OH
43230-5426
US

IV. Provider business mailing address

4200 BROMTON CT
GAHANNA OH
43230-5426
US

V. Phone/Fax

Practice location:
  • Phone: 614-563-3656
  • Fax:
Mailing address:
  • Phone: 614-563-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number374U00000X
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: