Healthcare Provider Details

I. General information

NPI: 1245144336
Provider Name (Legal Business Name): SHANNON DEE GUZASKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 SANDERSON AVE
CAMPBELL OH
44405-1407
US

IV. Provider business mailing address

290 SANDERSON AVE
CAMPBELL OH
44405-1407
US

V. Phone/Fax

Practice location:
  • Phone: 330-980-8729
  • Fax:
Mailing address:
  • Phone: 330-980-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: