Provider Demographics
NPI:1508043118
Name:JAP, SHANNON NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:NICOLE
Last Name:JAP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:571 HIGH ST STE 11
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4132
Mailing Address - Country:US
Mailing Address - Phone:614-226-5484
Mailing Address - Fax:937-606-3077
Practice Address - Street 1:571 HIGH ST STE 11
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4132
Practice Address - Country:US
Practice Address - Phone:614-226-5484
Practice Address - Fax:937-606-3077
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0015982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry