Healthcare Provider Details

I. General information

NPI: 1033984042
Provider Name (Legal Business Name): NICHOLAS SHAMHART
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8567 BRENTWOOD DR
OLMSTED TWP OH
44138-1853
US

IV. Provider business mailing address

8567 BRENTWOOD DR
OLMSTED TWP OH
44138-1853
US

V. Phone/Fax

Practice location:
  • Phone: 419-545-2719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: