Provider Demographics
NPI:1730315573
Name:FRYE, SHEILA FAITH
Entity Type:Individual
Prefix:MISS
First Name:SHEILA
Middle Name:FAITH
Last Name:FRYE
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:PO BOX 318
Mailing Address - Street 2:1159 MARYLAND ST
Mailing Address - City:ABERDEEN
Mailing Address - State:OH
Mailing Address - Zip Code:45101-0318
Mailing Address - Country:US
Mailing Address - Phone:937-795-2117
Mailing Address - Fax:
Practice Address - Street 1:1159 MARYLAND ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:OH
Practice Address - Zip Code:45101-9749
Practice Address - Country:US
Practice Address - Phone:937-795-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2929031376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2929031Medicaid