Provider Demographics
NPI:1104623347
Name:COLES, SHANTIA MISCHELLE
Entity type:Individual
Prefix:
First Name:SHANTIA
Middle Name:MISCHELLE
Last Name:COLES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2214
Mailing Address - Country:US
Mailing Address - Phone:419-860-9807
Mailing Address - Fax:
Practice Address - Street 1:508 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2214
Practice Address - Country:US
Practice Address - Phone:419-860-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker