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General NPI Number Information
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NPI Number | 1609248046
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Entity Type | Individual
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Provider Name | SHANE HENRY DUDA PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 627 EASTLAND AVE SE STE 102
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City | WARREN
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State | OH
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Zip | 44484-4501
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Country | US
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Telephone | 330-306-5030
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Fax |
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Provider Business Mailing Address
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Address Line | 627 EASTLAND AVE SE STE 102
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City | WARREN
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State | OH
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Zip | 44484-4501
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Country | US
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Telephone | 330-306-5030
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA057965
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.004537
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License Number State | OH
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