Provider Demographics
NPI:1215355516
Name:SYARTO, SHANNON (AUD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SYARTO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 NORTH RIDGE EAST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004
Mailing Address - Country:US
Mailing Address - Phone:440-992-0101
Mailing Address - Fax:440-992-0096
Practice Address - Street 1:26777 LORAIN RD
Practice Address - Street 2:SUITE 317
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-716-9200
Practice Address - Fax:440-716-9207
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01878237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050404Medicaid