Provider Demographics
NPI:1437278587
Name:SETTY-TROTTER, SHANNON RENEE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:SETTY-TROTTER
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 1:1797 STATE ROUTE 348
Mailing Address - Street 2:
Mailing Address - City:OTWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45657-8972
Mailing Address - Country:US
Mailing Address - Phone:740-372-2211
Mailing Address - Fax:
Practice Address - Street 1:230 SPRUCE LN LOT 14
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9599
Practice Address - Country:US
Practice Address - Phone:937-681-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2712514Medicaid