Healthcare Provider Details

I. General information

NPI: 1669852174
Provider Name (Legal Business Name): SHAWAN ANGEL DAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 CLOVERNOOK AVE
CINCINNATI OH
45231-3302
US

IV. Provider business mailing address

7920 CLOVERNOOK AVE
CINCINNATI OH
45231-3302
US

V. Phone/Fax

Practice location:
  • Phone: 513-344-2389
  • Fax:
Mailing address:
  • Phone: 513-344-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number0120884
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: