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NPI Code Detail

MEDICARE: DR. SHANNON NICOLE AVENA DO, MS

MEDICARE: DR. SHANNON NICOLE AVENA DO, MS
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
1207Q00000XFamily Medicine Physician34.016350OH
2207Q00000XFamily Medicine Physician5151014411MI

General Provider Information

NPI Number : 1780211581
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON NICOLE AVENA DO, MS
Provider Business Mailing Address
First Line : 700 ACKERMAN RD STE 2120
Second Line :
City : COLUMBUS
State : OH
Zip : 43202-1559
Country : US
Telephone Number : 614-685-2805
Fax Number :
Provider Business Practice Location Address
First Line : 278 BARKS RD W
Second Line :
City : MARION
State : OH
Zip : 43302-7367
Country : US
Telephone Number : 740-383-7080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2020
Last Update Date : 01/27/2026

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