Provider Demographics
NPI:1801486444
Name:CLONCH, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:CLONCH
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 1:1626 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PATRIOT
Mailing Address - State:OH
Mailing Address - Zip Code:45658-9270
Mailing Address - Country:US
Mailing Address - Phone:740-379-9517
Mailing Address - Fax:
Practice Address - Street 1:727 4TH AVE APT 105
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1500
Practice Address - Country:US
Practice Address - Phone:740-339-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider