Healthcare Provider Details

I. General information

NPI: 1689099251
Provider Name (Legal Business Name): DON SHEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 MANCHESTER RD
NEW FRANKLIN OH
44319-4654
US

IV. Provider business mailing address

6075 MANCHESTER RD
NEW FRANKLIN OH
44319-4654
US

V. Phone/Fax

Practice location:
  • Phone: 330-882-4133
  • Fax:
Mailing address:
  • Phone: 330-882-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberUA1004908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: