Provider Demographics
NPI:1306227517
Name:MATTHEWS, SHALIN
Entity Type:Individual
Prefix:
First Name:SHALIN
Middle Name:
Last Name:MATTHEWS
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 1:150 W SOUTH BOUNDARY ST # PMO214
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1754
Mailing Address - Country:US
Mailing Address - Phone:567-742-7177
Mailing Address - Fax:
Practice Address - Street 1:150 W SOUTH BOUNDARY ST # PMO214
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:567-742-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2018-07-20
Deactivation Date:2018-05-16
Deactivation Code:
Reactivation Date:2018-07-20
Provider Licenses
StateLicense IDTaxonomies
OH153517164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse