Provider Demographics
NPI:1033716337
Name:SHIRA, HOLLY NOEL
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:NOEL
Last Name:SHIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7612 SESSIS DR
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5318
Mailing Address - Country:US
Mailing Address - Phone:614-749-0104
Mailing Address - Fax:
Practice Address - Street 1:4806 KINGSHILL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6204
Practice Address - Country:US
Practice Address - Phone:614-749-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider