Provider Demographics
NPI:1518658046
Name:HAMILTON, SHANLEY MARIE II
Entity Type:Individual
Prefix:MRS
First Name:SHANLEY
Middle Name:MARIE
Last Name:HAMILTON
Suffix:II
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHANLEY
Other - Middle Name:MARIE
Other - Last Name:FURNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2336
Mailing Address - Country:US
Mailing Address - Phone:330-281-7143
Mailing Address - Fax:
Practice Address - Street 1:530 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2336
Practice Address - Country:US
Practice Address - Phone:330-281-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX434091073747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant