Provider Demographics
NPI:1619034204
Name:SHULTS, SHELLEY D (DDS, APRN-CNP)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:D
Last Name:SHULTS
Suffix:
Gender:F
Credentials:DDS, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CLAIREDAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065
Mailing Address - Country:US
Mailing Address - Phone:614-436-4433
Mailing Address - Fax:614-436-6055
Practice Address - Street 1:39 CLAIREDAN DRIVE
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065
Practice Address - Country:US
Practice Address - Phone:614-436-4433
Practice Address - Fax:614-436-6055
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024180363LF0000X, 207QS1201X
OH214031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine