MEDICARE: SHUNELLE HOLLIS LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	S.2613383	OH

General Provider Information

NPI Number	:	1346026093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUNELLE HOLLIS LSW

Provider Business Mailing Address
First Line	:	5107 FAIRWAY LAKES DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-5209
Country	:	US
Telephone Number	:	773-426-8428
Fax Number	:

Provider Business Practice Location Address
First Line	:	5107 FAIRWAY LAKES DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-5209
Country	:	US
Telephone Number	:	773-426-8428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	05/19/2026

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Directions to “ SHUNELLE HOLLIS LSW” Practice Location

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