Provider Demographics
NPI:1619274529
Name:SHIVELER, ERIN ASHLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ASHLEY
Last Name:SHIVELER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 MITCHAM DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5480
Mailing Address - Country:US
Mailing Address - Phone:850-425-1300
Mailing Address - Fax:850-219-1527
Practice Address - Street 1:2621 MITCHAM DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5480
Practice Address - Country:US
Practice Address - Phone:850-425-1300
Practice Address - Fax:850-219-1527
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN190101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice