Healthcare Provider Details

I. General information

NPI: 1942017512
Provider Name (Legal Business Name): SHANNON MARIE BOLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 GRANT ST
AKRON OH
44311-9910
US

IV. Provider business mailing address

629 ESSEX ST
AKRON OH
44306-3350
US

V. Phone/Fax

Practice location:
  • Phone: 330-376-9494
  • Fax:
Mailing address:
  • Phone: 330-524-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberFPS.000224
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: