Provider Demographics
NPI:1649242108
Name:MILLER, SHANNON COREY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:COREY
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 FAR HILLS AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1687
Mailing Address - Country:US
Mailing Address - Phone:937-297-3032
Mailing Address - Fax:937-496-1003
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1687
Practice Address - Country:US
Practice Address - Phone:937-297-3032
Practice Address - Fax:937-496-1003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0661812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry