Provider Demographics
NPI:1073331773
Name:OGLESBY, SHELANE (ND)
Entity type:Individual
Prefix:
First Name:SHELANE
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20315 SW VETA ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2058
Mailing Address - Country:US
Mailing Address - Phone:503-806-6149
Mailing Address - Fax:
Practice Address - Street 1:4246 SE BELMONT ST STE 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1676
Practice Address - Country:US
Practice Address - Phone:503-445-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath