Provider Demographics
NPI:1649447913
Name:REED, SHELLI IRENE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:SHELLI
Middle Name:IRENE
Last Name:REED
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 NELSON CT
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8826
Mailing Address - Country:US
Mailing Address - Phone:330-715-1403
Mailing Address - Fax:
Practice Address - Street 1:1225 HIGH ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9421
Practice Address - Country:US
Practice Address - Phone:330-335-7337
Practice Address - Fax:330-334-8309
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA09550363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics