Provider Demographics
NPI:1982721429
Name:BALENSIEFER, SHIELA M
Entity type:Individual
Prefix:MRS
First Name:SHIELA
Middle Name:M
Last Name:BALENSIEFER
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 1:1600 E MAIN STREET
Mailing Address - Street 2:POST OFFICE BOX 369
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122
Mailing Address - Country:US
Mailing Address - Phone:317-745-7503
Mailing Address - Fax:317-745-0663
Practice Address - Street 1:1600 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122
Practice Address - Country:US
Practice Address - Phone:317-745-7503
Practice Address - Fax:317-745-0663
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist