Provider Demographics
NPI:1629639240
Name:SHEETS, SHELBY LORRAINE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LORRAINE
Last Name:SHEETS
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 1:1211 BROADWAY ST # 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-7342
Mailing Address - Country:US
Mailing Address - Phone:513-262-7165
Mailing Address - Fax:
Practice Address - Street 1:10725 OLD POND DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45249-3532
Practice Address - Country:US
Practice Address - Phone:513-520-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH463648163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health