MEDICARE: DR. SHANNON COREY MILLER M.D.

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	2084P0800X	Psychiatry Physician	35-066181	OH

General Provider Information

NPI Number	:	1649242108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON COREY MILLER M.D.

Provider Business Mailing Address
First Line	:	2600 FAR HILLS AVE
Second Line	:	SUITE 315
City	:	DAYTON
State	:	OH
Zip	:	45419-1687
Country	:	US
Telephone Number	:	937-297-3032
Fax Number	:	937-496-1003

Provider Business Practice Location Address
First Line	:	2600 FAR HILLS AVE
Second Line	:	SUITE 315
City	:	DAYTON
State	:	OH
Zip	:	45419-1687
Country	:	US
Telephone Number	:	937-297-3032
Fax Number	:	937-496-1003

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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