Healthcare Provider Details

I. General information

NPI: 1558582205
Provider Name (Legal Business Name): MRS. BARBARA E. SHANAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 RICHIE DRIVE
WEST CARROLLTON OH
45449
US

IV. Provider business mailing address

510 RICHIE DRIVE
WEST CARROLLTON OH
45449
US

V. Phone/Fax

Practice location:
  • Phone: 937-866-6856
  • Fax:
Mailing address:
  • Phone: 937-866-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2708654
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: