Individual
PHYLLIS SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SOLE PROPRIETY
Contact information
Practice address
2193 DEERING AVE, DAYTON, OH 45406-2506
(937) 626-3561
Mailing address
2193 DEERING AVE, DAYTON, OH 45406-2506
(937) 626-3561
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
5707220
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2635956
—
OH
Enumeration date
08/06/2021
Last updated
08/06/2021
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