Provider Demographics
NPI:1891738621
Name:SHASTEEN, ELLA M
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:M
Last Name:SHASTEEN
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 1:7591 STATE ROUTE 164
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9382
Mailing Address - Country:US
Mailing Address - Phone:330-831-2298
Mailing Address - Fax:330-424-5439
Practice Address - Street 1:7591 STATE ROUTE 164
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9382
Practice Address - Country:US
Practice Address - Phone:330-831-2298
Practice Address - Fax:330-424-5439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2623629Medicaid
OH1500469OtherMRDD