Provider Demographics
NPI:1629950639
Name:SHELKO, SUSAN LAUREN (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LAUREN
Last Name:SHELKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 LAKE ROCKWELL RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9409
Mailing Address - Country:US
Mailing Address - Phone:234-806-6435
Mailing Address - Fax:
Practice Address - Street 1:2237 LAKE ROCKWELL RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9409
Practice Address - Country:US
Practice Address - Phone:234-806-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 376J00000X
OHRN-191706374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker