Provider Demographics
NPI:1801934161
Name:SHIRA, SARAH LYNN (MS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:SHIRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 COUNTY ROAD 184
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9359
Mailing Address - Country:US
Mailing Address - Phone:614-325-3555
Mailing Address - Fax:
Practice Address - Street 1:2550 COUNTY ROAD 184
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9359
Practice Address - Country:US
Practice Address - Phone:614-325-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-7712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094740Medicaid