MEDICARE: SHANNON HUFFMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1043942808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON HUFFMAN

Provider Business Mailing Address
First Line	:	1009 MIAMI ST
Second Line	:
City	:	URBANA
State	:	OH
Zip	:	43078-1941
Country	:	US
Telephone Number	:	937-508-7516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 MIAMI ST
Second Line	:
City	:	URBANA
State	:	OH
Zip	:	43078-1941
Country	:	US
Telephone Number	:	937-508-7516
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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Directions to “ SHANNON HUFFMAN ” Practice Location

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