Provider Demographics
NPI:1265542344
Name:SHILLINGLAW, REGINA DILLINGHAM
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:DILLINGHAM
Last Name:SHILLINGLAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:RUTH
Other - Last Name:DILLINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88 MDOS/SGOHE/MENTAL HEALTH
Mailing Address - Street 2:WRIGHT PATTERSON MEDICAL CENTER
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433
Mailing Address - Country:US
Mailing Address - Phone:937-257-6876
Mailing Address - Fax:937-656-1192
Practice Address - Street 1:88 MDOS/SGOHE/MENTAL HEALTH
Practice Address - Street 2:WRIGHT PATTERSON MEDICAL CENTER
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-257-6876
Practice Address - Fax:937-656-1192
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2759103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000351Medicaid
045U7Medicare UPIN
NC282OU73AMedicare ID - Type Unspecified