=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366862096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BELINDA REED PHYSICIAN ASSISTANT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2014
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1435 SHOUP MILL RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45414-3978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-275-3488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4391 STATE ROUTE 47 E
-----------------------------------------------------
City | BELLEFONTAINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43311-9546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-415-2646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA16204
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 50.008060
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------