Healthcare Provider Details

I. General information

NPI: 1740092246
Provider Name (Legal Business Name): SIERRA NICOLE SHIDLER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 E WOODRUFF AVE
TOLEDO OH
43604-5342
US

IV. Provider business mailing address

544 E WOODRUFF AVE
TOLEDO OH
43604-5342
US

V. Phone/Fax

Practice location:
  • Phone: 419-214-4673
  • Fax:
Mailing address:
  • Phone: 419-214-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number435386
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number435386
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: