Provider Demographics
NPI:1982650750
Name:BUDDING, SHIRLEY JEAN (CNS, BC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:BUDDING
Suffix:
Gender:F
Credentials:CNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 PHILADELPHIA DR
Mailing Address - Street 2:STE 4505
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1813
Mailing Address - Country:US
Mailing Address - Phone:937-734-4363
Mailing Address - Fax:937-734-4181
Practice Address - Street 1:2222 PHILADELPHIA DR
Practice Address - Street 2:STE 4505
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1813
Practice Address - Country:US
Practice Address - Phone:937-734-4363
Practice Address - Fax:937-734-4181
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS04423364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2660642Medicaid
OHP94750Medicare UPIN
OHH456671Medicare PIN
OH2660642Medicaid