Provider Demographics
NPI:1902420664
Name:AMBURGEY, SHELLY K
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:K
Last Name:AMBURGEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3617
Mailing Address - Country:US
Mailing Address - Phone:937-514-2051
Mailing Address - Fax:
Practice Address - Street 1:3401 HAMPTON PL
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3617
Practice Address - Country:US
Practice Address - Phone:937-514-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant