Provider Demographics
NPI:1386355816
Name:VONNER, SHIVELLA
Entity type:Individual
Prefix:MRS
First Name:SHIVELLA
Middle Name:
Last Name:VONNER
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 1:3141 WARSAW ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1848
Mailing Address - Country:US
Mailing Address - Phone:419-410-4933
Mailing Address - Fax:
Practice Address - Street 1:3141 WARSAW ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1848
Practice Address - Country:US
Practice Address - Phone:419-410-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator