MEDICARE: SHAWN THOMAS MARTIN MSN, APRN, PMHNP

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	163W00000X	Registered Nurse	RN.406433	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0031656	OH

General Provider Information

NPI Number	:	1134851751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN THOMAS MARTIN MSN, APRN, PMHNP

Provider Business Mailing Address
First Line	:	851 EDENRIDGE DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-3128
Country	:	US
Telephone Number	:	330-466-9328
Fax Number	:

Provider Business Practice Location Address
First Line	:	8261 MARKET ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:

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

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	01/14/2024

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