Healthcare Provider Details

I. General information

NPI: 1902716616
Provider Name (Legal Business Name): SHANNON ITALIANO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
NEWARK OH
43055-3699
US

IV. Provider business mailing address

1320 W MAIN ST
NEWARK OH
43055-3699
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-3593
  • Fax: 220-564-3570
Mailing address:
  • Phone: 220-564-3593
  • Fax: 220-564-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN.397006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: