MEDICARE: MR. SHAWN CEDRIC RICHARDS APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.020544	OH

General Provider Information

NPI Number	:	1104366731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN CEDRIC RICHARDS APRN-CNP

Provider Business Mailing Address
First Line	:	PO BOX 80960
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708
Country	:	US
Telephone Number	:	330-871-8018
Fax Number	:	330-363-7770

Provider Business Practice Location Address
First Line	:	1909 WILLIAMSBURG WAY NE
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-8781
Country	:	US
Telephone Number	:	330-871-8018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	10/31/2025

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