Provider Demographics
NPI:1316765340
Name:EDMONDS, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:EDMONDS
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 1:27 TOWNSHIP ROAD 1025
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-7858
Mailing Address - Country:US
Mailing Address - Phone:740-861-1596
Mailing Address - Fax:
Practice Address - Street 1:30 E BROAD ST FL 22
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3414
Practice Address - Country:US
Practice Address - Phone:614-466-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant