Provider Demographics
NPI:1396211397
Name:MINOR, SHELIA
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:
Last Name:MINOR
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 1:2333 GLENCREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-4519
Mailing Address - Country:US
Mailing Address - Phone:469-443-2081
Mailing Address - Fax:
Practice Address - Street 1:5648 VICTORIA PLACE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112
Practice Address - Country:US
Practice Address - Phone:469-989-9434
Practice Address - Fax:469-443-2084
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty