Healthcare Provider Details

I. General information

NPI: 1033689492
Provider Name (Legal Business Name): ADREANNA SHONELLE MENDENHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 MARKET ST
YOUNGSTOWN OH
44512-6703
US

IV. Provider business mailing address

7950 MARKET ST APT 2
YOUNGSTOWN OH
44512-5934
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 330-757-0000
Mailing address:
  • Phone: 330-965-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS1440158
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: