Provider Demographics
NPI:1649225442
Name:SHOLLENBERGER, LEE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE ANN
Middle Name:
Last Name:SHOLLENBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 COLUMBIA RD
Mailing Address - Street 2:#106
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1487
Mailing Address - Country:US
Mailing Address - Phone:440-808-0530
Mailing Address - Fax:440-808-0916
Practice Address - Street 1:27378 W OVIATT RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2139
Practice Address - Country:US
Practice Address - Phone:440-871-4700
Practice Address - Fax:440-871-4702
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0213076Medicaid
OHG39986Medicare UPIN
OH0213076Medicaid