Healthcare Provider Details

I. General information

NPI: 1306434758
Provider Name (Legal Business Name): MRS. SHELIA ANN CAULEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SHELIA ANN UNDERWOOD

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 SHAWNEE TRL
POWELL OH
43065-5022
US

IV. Provider business mailing address

4491 S US HIGHWAY 45
OSHKOSH WI
54902-7471
US

V. Phone/Fax

Practice location:
  • Phone: 614-318-5375
  • Fax:
Mailing address:
  • Phone: 920-279-7905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: