Provider Demographics
NPI:1417717935
Name:MILLER, SHYLAH MAY
Entity Type:Individual
Prefix:
First Name:SHYLAH
Middle Name:MAY
Last Name:MILLER
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 1:23100 STONE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43447-9581
Mailing Address - Country:US
Mailing Address - Phone:419-392-8670
Mailing Address - Fax:
Practice Address - Street 1:23100 STONE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:OH
Practice Address - Zip Code:43447-9581
Practice Address - Country:US
Practice Address - Phone:419-392-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF12230199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine