Provider Demographics
NPI:1639222656
Name:SHELENBERGER, SANDRA K (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:SHELENBERGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6859 BUSHNELL RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-8612
Mailing Address - Country:US
Mailing Address - Phone:440-594-2839
Mailing Address - Fax:
Practice Address - Street 1:6859 BUSHNELL RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-8612
Practice Address - Country:US
Practice Address - Phone:440-594-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN172351163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2267407Medicaid