Healthcare Provider Details

I. General information

NPI: 1982534301
Provider Name (Legal Business Name): SHANNON MURDOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N STATE ST STE 250
WESTERVILLE OH
43082-8082
US

IV. Provider business mailing address

925 N STATE ST STE 250
WESTERVILLE OH
43082-8082
US

V. Phone/Fax

Practice location:
  • Phone: 614-627-1860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042410
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number454927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: