Provider Demographics
NPI:1124549258
Name:MARTIN, SHAWNNALOVE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNNALOVE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 DEWALT AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-4771
Mailing Address - Country:US
Mailing Address - Phone:330-844-6601
Mailing Address - Fax:
Practice Address - Street 1:731 DEWALT AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-4771
Practice Address - Country:US
Practice Address - Phone:330-844-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty