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NPI Code Detail

MEDICARE: SHELLY J GELONECK P.A

MEDICARE: SHELLY J GELONECK P.A
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
1363A00000XPhysician Assistant41.5001OH
2363A00000XPhysician Assistant50.001999OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1383047893OTHEROHANTHEM BC/BS
2383047893OTHEROHAETNA
3383047893OTHEROHUNITED HEALTH CARE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356426639
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLY J GELONECK P.A
Provider Business Mailing Address
First Line : 7700 WASHINGTON VILLAGE DR STE 220
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4094
Country : US
Telephone Number : 937-438-3132
Fax Number : 937-438-0902
Provider Business Practice Location Address
First Line : 7700 WASHINGTON VILLAGE DR STE 220
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4094
Country : US
Telephone Number : 937-438-3132
Fax Number : 937-438-0902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 02/06/2024

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Directions to “ SHELLY J GELONECK P.A” Practice Location

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