Provider Demographics
NPI:1598008104
Name:WERNER, SHELBY SPARE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:SPARE
Last Name:WERNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:NICOLE
Other - Last Name:SPARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3708 N BERKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1455 S FORT THOMAS AVE
Practice Address - Street 2:BLDG 1475
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2453
Practice Address - Country:US
Practice Address - Phone:859-442-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1722103TC0700X
OH6959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical