Healthcare Provider Details

I. General information

NPI: 1760242143
Provider Name (Legal Business Name): SHAUN COOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E EXCHANGE ST STE 600
AKRON OH
44308-1519
US

IV. Provider business mailing address

3618 W MARKET ST STE 15
FAIRLAWN OH
44333-2425
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-3293
  • Fax:
Mailing address:
  • Phone: 234-466-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2605138-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: