Provider Demographics
NPI:1285791467
Name:BARNEY, SHELLEY MARIE (PA-C,MPAS)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:MARIE
Last Name:BARNEY
Suffix:
Gender:F
Credentials:PA-C,MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:450B WASHINGTON JACKSON RD STE 108
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7601
Practice Address - Country:US
Practice Address - Phone:937-456-8330
Practice Address - Fax:937-456-8335
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001597363AM0700X
OH50.001597RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1046561OtherNATIONAL CERTIFICATION NU
OH50.001597OtherP.A. REGISTRATION NUMBER
OH41-3208OtherOHIO SUPERVISORY AGREEMEN