1972892180 NPI number — DR. MICHELLE SUZANNE SCHULTZ PSYD

Table of content: DR. MICHELLE SUZANNE SCHULTZ PSYD (NPI 1972892180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972892180 NPI number — DR. MICHELLE SUZANNE SCHULTZ PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULTZ
Provider First Name:
MICHELLE
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972892180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 WOODMAN DR
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45432-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-254-9210
Provider Business Mailing Address Fax Number:
937-254-9267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 N EDWIN C MOSES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45402-8470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-775-4333
Provider Business Practice Location Address Fax Number:
937-775-4323
Provider Enumeration Date:
03/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  6633 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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