Healthcare Provider Details

I. General information

NPI: 1215537956
Provider Name (Legal Business Name): SHAWNTE M BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 ROCKY BROOK DR APT B
AKRON OH
44313-8824
US

IV. Provider business mailing address

885 ROCKY BROOK DR APT B
AKRON OH
44313-8824
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-8685
  • Fax:
Mailing address:
  • Phone: 234-334-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: