Individual
SHANA LYNETTE MUNDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
345 LARCHMONT AVE, SPRINGFIELD, OH 45503-5423
(937) 631-5017
Mailing address
345 LARCHMONT AVE, SPRINGFIELD, OH 45503-5423
(937) 631-5017
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1203629
—
OH
Enumeration date
12/28/2020
Last updated
12/28/2020
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