Provider Demographics
NPI:1730531120
Name:SHELLIE L. GRAF
Entity type:Organization
Organization Name:SHELLIE L. GRAF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-723-8880
Mailing Address - Street 1:5164 NORMANDY PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5901
Mailing Address - Country:US
Mailing Address - Phone:330-723-8880
Mailing Address - Fax:330-723-8880
Practice Address - Street 1:8510 MENTOR AVE STE B
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5841
Practice Address - Country:US
Practice Address - Phone:330-723-8880
Practice Address - Fax:330-723-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0947999Medicaid
OH0602880002Medicare NSC