Provider Demographics
NPI:1548027154
Name:GAGE, SHATEERA (CCHW, MHA, BS)
Entity type:Individual
Prefix:MRS
First Name:SHATEERA
Middle Name:
Last Name:GAGE
Suffix:
Gender:F
Credentials:CCHW, MHA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5433
Mailing Address - Country:US
Mailing Address - Phone:513-265-5075
Mailing Address - Fax:
Practice Address - Street 1:2750 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-5433
Practice Address - Country:US
Practice Address - Phone:513-265-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCHW.001704172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty