Healthcare Provider Details

I. General information

NPI: 1033927868
Provider Name (Legal Business Name): SHAWN GEBAN APSS, CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 PORTLAND AVE SUITE 101
LOUISVILLE KY
40212
US

IV. Provider business mailing address

2512 PORTLAND AVE SUITE 101
LOUISVILLE KY
40212
US

V. Phone/Fax

Practice location:
  • Phone: 502-501-3788
  • Fax: 502-999-9910
Mailing address:
  • Phone: 502-501-3788
  • Fax: 502-999-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: