Provider Demographics
NPI:1235873068
Name:NELSON-OLIVER, SHANTA S
Entity Type:Individual
Prefix:
First Name:SHANTA
Middle Name:S
Last Name:NELSON-OLIVER
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 1:246 BON AIR AVE
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-4116
Mailing Address - Country:US
Mailing Address - Phone:440-371-5864
Mailing Address - Fax:
Practice Address - Street 1:246 BON AIR AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-4116
Practice Address - Country:US
Practice Address - Phone:440-371-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker