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General NPI Number Information
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NPI Number | 1659854362
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Entity Type | Individual
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Provider Name | SHELBY CASSANDRA WYANT
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Gender | Female
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Dates
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Enumeration Date | 09/09/2018
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Last Update Date | 09/09/2018
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Provider Practice Location Address
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Address Line | 765 PIERCE DR
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City | COLUMBUS
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State | OH
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Zip | 43223-2425
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Country | US
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Telephone | 614-223-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 567 SHERIDAN AVE
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City | BEXLEY
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State | OH
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Zip | 43209-2325
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Country | US
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Telephone | 567-224-9091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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