Healthcare Provider Details

I. General information

NPI: 1134851751
Provider Name (Legal Business Name): SHAWN THOMAS MARTIN MSN, APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 01/14/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 MARKET ST
YOUNGSTOWN OH
44512-6254
US

IV. Provider business mailing address

851 EDENRIDGE DR
YOUNGSTOWN OH
44512-3128
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-0050
  • Fax:
Mailing address:
  • Phone: 330-466-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0031656
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.406433
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: