Provider Demographics
NPI:1811878382
Name:FOSTER, SHELBY (PEER SUPPORT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 OTOOLE DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-4323
Mailing Address - Country:US
Mailing Address - Phone:937-946-4028
Mailing Address - Fax:
Practice Address - Street 1:765 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1960
Practice Address - Country:US
Practice Address - Phone:937-505-1877
Practice Address - Fax:800-480-7578
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006827175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty