Provider Demographics
NPI:1083483929
Name:MILLER, SHANELLA ANN (CPSS)
Entity Type:Individual
Prefix:
First Name:SHANELLA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N BROADWAY APT 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2246
Mailing Address - Country:US
Mailing Address - Phone:859-551-5995
Mailing Address - Fax:
Practice Address - Street 1:516 N BROADWAY APT 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2246
Practice Address - Country:US
Practice Address - Phone:859-241-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist