MEDICARE: SHANNON BAILEY CNP

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	363L00000X	Nurse Practitioner	323228	OH

General Provider Information

NPI Number	:	1679113211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BAILEY CNP

Provider Business Mailing Address
First Line	:	PO BOX 80690
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-0690
Country	:	US
Telephone Number	:	330-763-4444
Fax Number	:	330-763-7770

Provider Business Practice Location Address
First Line	:	2600 TUSCARAWAS ST W
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-4644
Country	:	US
Telephone Number	:	330-363-7444
Fax Number	:	330-363-7770

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

Provider Enumeration Date	:	01/12/2020
Last Update Date	:	03/03/2026

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Directions to “ SHANNON BAILEY CNP” Practice Location

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