Healthcare Provider Details

I. General information

NPI: 1932020203
Provider Name (Legal Business Name): SHANON HOADLEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5832 FAIRWAY DR
MASON OH
45040-8334
US

IV. Provider business mailing address

5832 FAIRWAY DR
MASON OH
45040-8334
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1302587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: