Provider Demographics
NPI:1366793366
Name:WRIGHT, SHALON CAROLYN
Entity type:Individual
Prefix:MRS
First Name:SHALON
Middle Name:CAROLYN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHALON
Other - Middle Name:CAROLYN
Other - Last Name:SAYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2611 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1833
Mailing Address - Country:US
Mailing Address - Phone:937-641-8558
Mailing Address - Fax:
Practice Address - Street 1:1121 CHELSEA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-3064
Practice Address - Country:US
Practice Address - Phone:937-422-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN397751163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health