Provider Demographics
NPI:1558003368
Name:HARDIN, SHAWNTE DAVON
Entity Type:Individual
Prefix:
First Name:SHAWNTE
Middle Name:DAVON
Last Name:HARDIN
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 1:1831 MOOBERRY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-3092
Mailing Address - Country:US
Mailing Address - Phone:330-245-4926
Mailing Address - Fax:
Practice Address - Street 1:1831 MOOBERRY ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-3092
Practice Address - Country:US
Practice Address - Phone:330-245-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide