Provider Demographics
NPI:1467860403
Name:MCELROY, SHIRLEY ANN II
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:MCELROY
Suffix:II
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 1:1125 WADE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3269
Mailing Address - Country:US
Mailing Address - Phone:330-680-4812
Mailing Address - Fax:330-680-4812
Practice Address - Street 1:1125 WADE AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3269
Practice Address - Country:US
Practice Address - Phone:330-680-4812
Practice Address - Fax:330-680-4812
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2207285172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker