Provider Demographics
NPI:1104366731
Name:RICHARDS, SHAWN CEDRIC (APRN-CNP)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:CEDRIC
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:MR
Other - First Name:SHAWN
Other - Middle Name:C
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN
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:330-325-3202
Mailing Address - Fax:833-606-1565
Practice Address - Street 1:4211 STATE ROUTE 44 STE 203
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9733
Practice Address - Country:US
Practice Address - Phone:330-325-3202
Practice Address - Fax:833-606-1565
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily