Provider Demographics
NPI:1578759825
Name:PEDANI, SHAWN ANDREW (LISW-S)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:ANDREW
Last Name:PEDANI
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 CHRIS CIR
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-9326
Mailing Address - Country:US
Mailing Address - Phone:330-806-1459
Mailing Address - Fax:
Practice Address - Street 1:741 CHRIS CIR
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9326
Practice Address - Country:US
Practice Address - Phone:330-806-1459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI080003251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical