Provider Demographics
NPI:1427428929
Name:DUNN, SHEILA (PMHNP-BC, RN, MSN)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:PMHNP-BC, RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5037
Mailing Address - Country:US
Mailing Address - Phone:937-318-8103
Mailing Address - Fax:937-867-5258
Practice Address - Street 1:302 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-5037
Practice Address - Country:US
Practice Address - Phone:937-281-4673
Practice Address - Fax:937-318-1120
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005924A363LP0808X
OHCOA 18073-NP364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000971529OtherANTHEM
IN201329390Medicaid
OH0147593Medicaid
OH0147593Medicaid