Provider Demographics
NPI:1497239149
Name:SABIN, SHAUN ANTHONY
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:ANTHONY
Last Name:SABIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 REVERE AVE APT K
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1870
Mailing Address - Country:US
Mailing Address - Phone:937-815-9212
Mailing Address - Fax:
Practice Address - Street 1:6929 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2563
Practice Address - Country:US
Practice Address - Phone:937-259-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator