Provider Demographics
NPI:1285372516
Name:WORTHY, SHANELL LASHAY
Entity type:Individual
Prefix:
First Name:SHANELL
Middle Name:LASHAY
Last Name:WORTHY
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 1:350 LOOKOUT AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1937
Mailing Address - Country:US
Mailing Address - Phone:937-607-3014
Mailing Address - Fax:
Practice Address - Street 1:350 LOOKOUT AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1937
Practice Address - Country:US
Practice Address - Phone:937-607-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251E00000XAgenciesHome Health