Provider Demographics
NPI:1073885216
Name:BREEDING, SHAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BREEDING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 EDWIN C. MOSES BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3474
Mailing Address - Country:US
Mailing Address - Phone:937-424-1000
Mailing Address - Fax:937-424-1002
Practice Address - Street 1:627 EDWIN C. MOSES BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3474
Practice Address - Country:US
Practice Address - Phone:937-424-1000
Practice Address - Fax:937-424-1002
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant