Healthcare Provider Details

I. General information

NPI: 1144806506
Provider Name (Legal Business Name): MATTHEW SHENEMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WPAFB OH
45433-5529
US

IV. Provider business mailing address

4257 AMARYLLIS DR APT A
SUGARCREEK TOWNSHIP OH
45459-7183
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-0770
  • Fax:
Mailing address:
  • Phone: 908-399-5463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH0097916
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.017375
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: