Healthcare Provider Details

I. General information

NPI: 1942725130
Provider Name (Legal Business Name): SHANNON DRISCOLL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 VICTORY PKWY STE 602
CINCINNATI OH
45206-2837
US

IV. Provider business mailing address

4945 RELLEUM AVE
CINCINNATI OH
45238-3805
US

V. Phone/Fax

Practice location:
  • Phone: 513-429-2073
  • Fax:
Mailing address:
  • Phone: 716-860-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number442583
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0032857
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: