Provider Demographics
NPI:1043425010
Name:PACE, SHEILA JO
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:JO
Last Name:PACE
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 1:7743 SPIDEL RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45308-9517
Mailing Address - Country:US
Mailing Address - Phone:937-621-3440
Mailing Address - Fax:
Practice Address - Street 1:7743 SPIDEL RD
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:OH
Practice Address - Zip Code:45308-9517
Practice Address - Country:US
Practice Address - Phone:937-621-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2667225Medicaid