Healthcare Provider Details

I. General information

NPI: 1033179817
Provider Name (Legal Business Name): SHANNON K BENTLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8638 OLD TROY PIKE STE A
HUBER HEIGHTS OH
45424-1051
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B2ND
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-5100
  • Fax: 937-641-2684
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22184
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49699
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.075269
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number49699
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: