Provider Demographics
NPI:1497144877
Name:PRITCHETT, SHAWNTAY (LPN, LMT)
Entity Type:Individual
Prefix:
First Name:SHAWNTAY
Middle Name:
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:LPN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4879 HAMILTON AVE
Mailing Address - Street 2:BLDG. D
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1505
Mailing Address - Country:US
Mailing Address - Phone:513-614-4443
Mailing Address - Fax:
Practice Address - Street 1:4879 HAMILTON AVE
Practice Address - Street 2:BLDG. D
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1505
Practice Address - Country:US
Practice Address - Phone:513-614-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 102176-MEDS164W00000X
OH33.021538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse