Provider Demographics
NPI:1639652548
Name:HOLLOMAN, SHELBY SZYCH
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:SZYCH
Last Name:HOLLOMAN
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 1:4126 N HOLLAND SYLVANIA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3537
Mailing Address - Country:US
Mailing Address - Phone:419-517-7600
Mailing Address - Fax:419-517-7598
Practice Address - Street 1:2702 NAVARRE AVE STE 302
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3224
Practice Address - Country:US
Practice Address - Phone:419-696-3280
Practice Address - Fax:419-696-3281
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
MI4704317661367A00000X
OHAPRNCNM019381367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.414556OtherRN LICENSE