Healthcare Provider Details

I. General information

NPI: 1205494739
Provider Name (Legal Business Name): MEGHAN SHACKFORD DAWSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGHAN CLARE SHACKFORD DO

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

128 E APPLE ST STE 3800
DAYTON OH
45409-2902
US

V. Phone/Fax

Practice location:
  • Phone: 802-338-0875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number58.031055
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number77643-21
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number58.031055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: