Individual
DR. JENNIFER MARIE SHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
89 SYLVANIA DR, BEAVERCREEK, OH 45440-3281
(937) 320-2020
Mailing address
89 SYLVANIA DR, BEAVERCREEK, OH 45440-3281
(937) 320-2020
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35123554
OH
207W00000X
Ophthalmology Physician
56584
MN
Other
Enumeration date
08/13/2009
Last updated
11/04/2014
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