Provider Demographics
NPI:1437956901
Name:GENTRY, ERICA SHELBY (SPECIALIST)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:SHELBY
Last Name:GENTRY
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 UPPERTON DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-1420
Mailing Address - Country:US
Mailing Address - Phone:513-571-0540
Mailing Address - Fax:
Practice Address - Street 1:5105 UPPERTON DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-1420
Practice Address - Country:US
Practice Address - Phone:513-571-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician