Provider Demographics
NPI:1508636747
Name:SHELLENBARGER, GWENDOLYN ANNE
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:ANNE
Last Name:SHELLENBARGER
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 1:8585 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-1641
Mailing Address - Country:US
Mailing Address - Phone:440-826-9546
Mailing Address - Fax:440-826-9915
Practice Address - Street 1:8585 PEARL RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-1641
Practice Address - Country:US
Practice Address - Phone:440-826-9546
Practice Address - Fax:440-826-9915
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017145-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician