Healthcare Provider Details

I. General information

NPI: 1053065102
Provider Name (Legal Business Name): GREG L SHETTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LIBERTY LN
WEST CARROLLTON OH
45449-2135
US

IV. Provider business mailing address

455 E. DUBLIN GRANVILLE ROAD
WORTHINGTON OH
43085-1649
US

V. Phone/Fax

Practice location:
  • Phone: 937-247-2400
  • Fax:
Mailing address:
  • Phone: 614-844-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2507120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: