Healthcare Provider Details

I. General information

NPI: 1396994661
Provider Name (Legal Business Name): SHANNON MARIE CHEEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

DEPT 781625 P.O. BOX 78000
DETROIT MI
48278-1625
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-8212
  • Fax: 614-722-3235
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35.120121
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.120121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: