Basic Information
| Provider Information | |||||||||
| NPI: | 1386653756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | SHAUNA | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7677 YANKEE ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454593475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374549527 | ||||||||
| FaxNumber: | 9374549532 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 NEEDMORE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454143969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372774274 | ||||||||
| FaxNumber: | 9372778476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 50001856 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 0067772 | 05 | OH | MEDICAID |