Provider Demographics
NPI:1417424375
Name:BERNECKER, SHAUNCEY MARIAH-KAY (NP)
Entity Type:Individual
Prefix:
First Name:SHAUNCEY
Middle Name:MARIAH-KAY
Last Name:BERNECKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHAUNCEY
Other - Middle Name:MARIAH-KAY
Other - Last Name:TURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7545 BEECHMONT AVE STE D
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4238
Practice Address - Country:US
Practice Address - Phone:513-206-1320
Practice Address - Fax:513-232-8483
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.023879363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health