Healthcare Provider Details

I. General information

NPI: 1326978834
Provider Name (Legal Business Name): DANELL ANN SHIREY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S 4TH AVE
SIDNEY OH
45365-9029
US

IV. Provider business mailing address

104 BLACKWELL DR
PIQUA OH
45356-4211
US

V. Phone/Fax

Practice location:
  • Phone: 937-497-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number09763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: