Provider Demographics
NPI:1689397085
Name:MCNEELY, SIDRA AGHAVNIE
Entity Type:Individual
Prefix:
First Name:SIDRA
Middle Name:AGHAVNIE
Last Name:MCNEELY
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 1:1506 CHESTNUT GROVE CT
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-7520
Mailing Address - Country:US
Mailing Address - Phone:937-823-9367
Mailing Address - Fax:
Practice Address - Street 1:1506 CHESTNUT GROVE CT
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-7520
Practice Address - Country:US
Practice Address - Phone:937-823-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 374U00000X, 376J00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide