Provider Demographics
NPI:1093159964
Name:MCKEEN, SHANNON N (DO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:N
Last Name:MCKEEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 AUBURN RD STE 301
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9618
Mailing Address - Country:US
Mailing Address - Phone:440-352-7546
Mailing Address - Fax:440-352-5260
Practice Address - Street 1:7580 AUBURN RD STE 301
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9618
Practice Address - Country:US
Practice Address - Phone:440-352-7546
Practice Address - Fax:440-352-5260
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34012704207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology