Healthcare Provider Details

I. General information

NPI: 1235455403
Provider Name (Legal Business Name): SHANNEL R ADAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7675 WELLNESS WAY STE 315
WEST CHESTER OH
45069-2509
US

IV. Provider business mailing address

7675 WELLNESS WAY STE 315
WEST CHESTER OH
45069-2509
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-7657
  • Fax:
Mailing address:
  • Phone: 513-475-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number57.022223
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number57.022223
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: