MEDICARE: SHADEJA NELSON

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

General Provider Information

NPI Number	:	1417457755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADEJA NELSON

Provider Business Mailing Address
First Line	:	1515 INDIANOLA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-2118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	657 S OHIO AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2743
Country	:	US
Telephone Number	:	614-258-8043
Fax Number	:

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

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	02/13/2018

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Directions to “ SHADEJA NELSON ” Practice Location

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