Provider Demographics
NPI:1821280322
Name:MILLS, SHELLY KAY (MD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:KAY
Last Name:MILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25568 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-9003
Mailing Address - Country:US
Mailing Address - Phone:419-782-2147
Mailing Address - Fax:419-822-9008
Practice Address - Street 1:25568 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-9003
Practice Address - Country:US
Practice Address - Phone:419-782-2147
Practice Address - Fax:419-822-9008
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3045234Medicaid
OH4295751Medicare PIN