Healthcare Provider Details

I. General information

NPI: 1316869100
Provider Name (Legal Business Name): SHANNON DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 BALTIMORE REYNOLDSBURG RD UNIT 696
REYNOLDSBURG OH
43068-8105
US

IV. Provider business mailing address

1929 BALTIMORE REYNOLDSBURG RD UNIT 696
REYNOLDSBURG OH
43068-8105
US

V. Phone/Fax

Practice location:
  • Phone: 614-857-5352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: