Provider Demographics
NPI:1821708579
Name:COLLINS, SHELLY R
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:R
Last Name:COLLINS
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 1:1215 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4117
Mailing Address - Country:US
Mailing Address - Phone:513-849-2081
Mailing Address - Fax:513-849-2071
Practice Address - Street 1:1215 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4117
Practice Address - Country:US
Practice Address - Phone:513-849-2081
Practice Address - Fax:513-849-2081
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist