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General NPI Number Information
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NPI Number | 1134851751
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Entity Type | Individual
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Provider Name | SHAWN THOMAS MARTIN MSN, APRN, PMHNP
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Gender | Male
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 01/14/2024
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Provider Practice Location Address
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Address Line | 8261 MARKET ST
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-6254
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Country | US
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Telephone | 330-286-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 851 EDENRIDGE DR
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-3128
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Country | US
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Telephone | 330-466-9328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.406433
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0031656
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License Number State | OH
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