Healthcare Provider Details

I. General information

NPI: 1679113211
Provider Name (Legal Business Name): SHANNON BAILEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W EXCHANGE ST
AKRON OH
44302-1711
US

IV. Provider business mailing address

PO BOX 933428
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 800-230-7526
  • Fax: 720-738-8684
Mailing address:
  • Phone: 800-230-7526
  • Fax: 720-739-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number323228
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: