Provider Demographics
NPI:1083184725
Name:DEATS, SHAWN M
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:DEATS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8155
Mailing Address - Fax:614-293-3565
Practice Address - Street 1:915 OLENTANGY RIVER RD STE 2000
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3159
Practice Address - Country:US
Practice Address - Phone:614-293-8155
Practice Address - Fax:614-293-3565
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF09181760363LF0000X
OHAPRN.CNP.024001363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1083184725Medicaid