Individual
SHELLY J GELONECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
7700 WASHINGTON VILLAGE DR STE 220, CENTERVILLE, OH 45459-4094
(937) 438-3132
(937) 438-0902
Mailing address
7700 WASHINGTON VILLAGE DR STE 220, CENTERVILLE, OH 45459-4094
(937) 438-3132
(937) 438-0902
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
41.5001
OH
363A00000X
Physician Assistant
Primary
50.001999
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105384
—
OH
01
—
383047893
ANTHEM BC/BS
OH
Enumeration date
10/26/2006
Last updated
02/06/2024
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