Provider Demographics
NPI:1174682140
Name:SHILLING, TERRI L (DO)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:SHILLING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 S BROADWAY ST
Mailing Address - Street 2:PO BOX 796
Mailing Address - City:SUGARCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44681-9378
Mailing Address - Country:US
Mailing Address - Phone:330-852-0704
Mailing Address - Fax:330-852-4830
Practice Address - Street 1:126 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SUGARCREEK
Practice Address - State:OH
Practice Address - Zip Code:44681-9378
Practice Address - Country:US
Practice Address - Phone:330-852-0704
Practice Address - Fax:330-852-4830
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0241027Medicaid