Provider Demographics
NPI:1366254351
Name:SHRODER, HAILEY NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:NICOLE
Last Name:SHRODER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BURCHDALE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1433
Mailing Address - Country:US
Mailing Address - Phone:937-641-1235
Mailing Address - Fax:
Practice Address - Street 1:140 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-1369
Practice Address - Country:US
Practice Address - Phone:937-641-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant