Healthcare Provider Details

I. General information

NPI: 1639146822
Provider Name (Legal Business Name): SHELSEA LEA JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 LOONEY RD STE 203
PIQUA OH
45356-4149
US

IV. Provider business mailing address

300 HIGH ST FL 4
HAMILTON OH
45011-6078
US

V. Phone/Fax

Practice location:
  • Phone: 937-440-8687
  • Fax:
Mailing address:
  • Phone: 513-454-1460
  • Fax: 614-355-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-08-4088
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35-08-4088
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: