Provider Demographics
NPI:1558392894
Name:WHITE, SHAUN MATTHEW (PA)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:MATTHEW
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7222 MARIEMONT CRES
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3932
Mailing Address - Country:US
Mailing Address - Phone:513-746-9228
Mailing Address - Fax:513-732-8537
Practice Address - Street 1:3000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1921
Practice Address - Country:US
Practice Address - Phone:513-732-8278
Practice Address - Fax:513-732-8537
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002125363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000588608OtherANTHEM PIN
OHWHPA31631Medicare PIN