Provider Demographics
NPI:1699557686
Name:MARTINEZ, SHIRLAYANN DARCELL
Entity type:Individual
Prefix:
First Name:SHIRLAYANN
Middle Name:DARCELL
Last Name:MARTINEZ
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 1:2105 COMMONS RD N
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3411
Mailing Address - Country:US
Mailing Address - Phone:614-483-5863
Mailing Address - Fax:
Practice Address - Street 1:2105 COMMONS RD N
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3411
Practice Address - Country:US
Practice Address - Phone:614-483-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities