Healthcare Provider Details

I. General information

NPI: 1184146995
Provider Name (Legal Business Name): SHANNON R. PANDA APRN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 TIM TAM AVE
COLUMBUS OH
43230-1860
US

IV. Provider business mailing address

782 TIM TAM AVE
COLUMBUS OH
43230-1860
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPRN.CNS.019349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: