Provider Demographics
NPI:1366152860
Name:ADJEI DUAH, SHANELLE (LMT)
Entity type:Individual
Prefix:
First Name:SHANELLE
Middle Name:
Last Name:ADJEI DUAH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SHANELLE
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3324 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4039
Mailing Address - Country:US
Mailing Address - Phone:626-922-0454
Mailing Address - Fax:
Practice Address - Street 1:4701 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1939
Practice Address - Country:US
Practice Address - Phone:626-922-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025824225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist