Provider Demographics
NPI:1851807242
Name:ROSS, SHIRLEY MELDAVE (PCA)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MELDAVE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:MS
Other - First Name:SHIRLEY
Other - Middle Name:MELDAVE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1591 BUFFALO CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704
Mailing Address - Country:US
Mailing Address - Phone:304-356-4562
Mailing Address - Fax:304-558-4563
Practice Address - Street 1:1591 BUFFALO CREEK ROAD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:304-429-4599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0032626000OtherPROVIDER ID