Provider Demographics
NPI:1356629356
Name:RIDGE, SHELLI A
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:A
Last Name:RIDGE
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 1:8240 BECKETT PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-9313
Mailing Address - Country:US
Mailing Address - Phone:513-860-2888
Mailing Address - Fax:844-269-8327
Practice Address - Street 1:8240 BECKETT PARK DR STE A
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-9313
Practice Address - Country:US
Practice Address - Phone:513-860-2888
Practice Address - Fax:844-269-8327
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34011979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine