Provider Demographics
NPI:1902685910
Name:HARTER, SHELLEY DEANNE
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DEANNE
Last Name:HARTER
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 1:382 FRAZERS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45382-9611
Mailing Address - Country:US
Mailing Address - Phone:937-417-7999
Mailing Address - Fax:
Practice Address - Street 1:382 FRAZERS RD
Practice Address - Street 2:
Practice Address - City:WEST MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45382-9611
Practice Address - Country:US
Practice Address - Phone:937-417-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant