Individual
SHATARA O'NEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
155 POPLAR ST, DAYTON, OH 45415-2929
(937) 516-8037
Mailing address
155 POPLAR ST, DAYTON, OH 45415-2929
(937) 516-8037
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
SC872568
OH
Other
Enumeration date
10/19/2021
Last updated
10/19/2021
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