Provider Demographics
NPI:1689342644
Name:OSTDIEK, SHELLEY A
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:OSTDIEK
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 1:1760 SUGAR RUN TRL
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1175
Mailing Address - Country:US
Mailing Address - Phone:937-416-3671
Mailing Address - Fax:
Practice Address - Street 1:1760 SUGAR RUN TRL
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1175
Practice Address - Country:US
Practice Address - Phone:937-416-3671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347E00000XTransportation ServicesTransportation Broker