Provider Demographics
NPI:1528414497
Name:CLARK, SHAUNA
Entity Type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-1115
Mailing Address - Country:US
Mailing Address - Phone:740-992-1536
Mailing Address - Fax:740-992-1608
Practice Address - Street 1:700 E MAIN ST
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-1115
Practice Address - Country:US
Practice Address - Phone:740-992-1536
Practice Address - Fax:740-992-1608
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other