Provider Demographics
NPI:1790391670
Name:SHIVELEY, TAMMI J
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:J
Last Name:SHIVELEY
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 1:670 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-3121
Mailing Address - Country:US
Mailing Address - Phone:513-375-5309
Mailing Address - Fax:
Practice Address - Street 1:670 WOOD ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-3121
Practice Address - Country:US
Practice Address - Phone:513-375-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle