Healthcare Provider Details

I. General information

NPI: 1396968764
Provider Name (Legal Business Name): SHAWN L. MARCUS C.PED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2573 RICHMOND RD SUITE 385
LEXINGTON KY
40509-1700
US

IV. Provider business mailing address

3322 LEXINGTON RD
RICHMOND KY
40475-9145
US

V. Phone/Fax

Practice location:
  • Phone: 859-489-4780
  • Fax: 859-266-7888
Mailing address:
  • Phone: 859-489-4780
  • Fax: 859-623-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: