Healthcare Provider Details

I. General information

NPI: 1417415753
Provider Name (Legal Business Name): SHINA M CAUTHEN APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 UPHAM DR
COLUMBUS OH
43210-1250
US

IV. Provider business mailing address

700 ACKERMAN RD
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9600
  • Fax: 614-293-1456
Mailing address:
  • Phone: 614-293-9600
  • Fax: 614-293-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023916
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: