Healthcare Provider Details

I. General information

NPI: 1609956747
Provider Name (Legal Business Name): SHIRLEY PATTERSON DASH RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIRLEY PATTERSON WILKES RD LD

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 09/27/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 POWERS BLVD PARMA COMMUNITY GENERAL HOSPITAL
PARMA OH
44129-4495
US

IV. Provider business mailing address

19298 TRILLIUM TRAIL
STRONGSVILLE OH
44149-3146
US

V. Phone/Fax

Practice location:
  • Phone: 440-743-2150
  • Fax: 440-743-2280
Mailing address:
  • Phone: 440-572-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number177
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: