Healthcare Provider Details

I. General information

NPI: 1346944816
Provider Name (Legal Business Name): LINDSY FANELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST STE 140
SPRINGBORO OH
45066-2100
US

IV. Provider business mailing address

825 N MAIN ST STE 140
SPRINGBORO OH
45066-2100
US

V. Phone/Fax

Practice location:
  • Phone: 937-762-5000
  • Fax: 937-522-9824
Mailing address:
  • Phone: 937-762-5000
  • Fax: 937-522-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.018601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: