Provider Demographics
NPI:1003680547
Name:SYNERGY THERAPEUTICS HEALTH & WELLNESS
Entity Type:Organization
Organization Name:SYNERGY THERAPEUTICS HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:THAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:814-919-9355
Mailing Address - Street 1:8210 MACEDONIA BLVD
Mailing Address - Street 2:SUITE 3B-1010
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8210 MACEDONIA BLVD
Practice Address - Street 2:SUITE 3B-1010
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056
Practice Address - Country:US
Practice Address - Phone:814-919-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty