Provider Demographics
NPI:1295033835
Name:STRNAD, SHANE (FPMHNP)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:STRNAD
Suffix:
Gender:M
Credentials:FPMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 PARK AVE W
Mailing Address - Street 2:SUITE N
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2700
Mailing Address - Country:US
Mailing Address - Phone:419-529-4602
Mailing Address - Fax:419-529-4664
Practice Address - Street 1:1456 PARK AVE W
Practice Address - Street 2:SUITE N
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-2700
Practice Address - Country:US
Practice Address - Phone:419-529-4602
Practice Address - Fax:419-529-4664
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.347265163WP0808X
OHCOA 12933-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health