Provider Demographics
NPI:1164918322
Name:CANTRELL, SHARLA N (AGNP)
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:N
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 STONE MILL PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6282
Mailing Address - Country:US
Mailing Address - Phone:937-474-7000
Mailing Address - Fax:
Practice Address - Street 1:5440 CHARLESGATE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-1049
Practice Address - Country:US
Practice Address - Phone:937-237-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAG07180062207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine