Healthcare Provider Details

I. General information

NPI: 1326963091
Provider Name (Legal Business Name): SHYLOE STARK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 TYLERSVILLE RD
MASON OH
45040-2533
US

IV. Provider business mailing address

295 DAKOTA RUN
MAINEVILLE OH
45039-8276
US

V. Phone/Fax

Practice location:
  • Phone: 513-902-3630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: