Healthcare Provider Details

I. General information

NPI: 1043942808
Provider Name (Legal Business Name): SHANNON HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 MIAMI ST
URBANA OH
43078-1941
US

IV. Provider business mailing address

1009 MIAMI ST
URBANA OH
43078-1941
US

V. Phone/Fax

Practice location:
  • Phone: 937-508-7516
  • Fax:
Mailing address:
  • Phone: 937-508-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: