Provider Demographics
NPI:1609033125
Name:MCAFEE, SHANNON NIKOLE (DO)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NIKOLE
Last Name:MCAFEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2207
Mailing Address - Country:US
Mailing Address - Phone:937-435-6222
Mailing Address - Fax:
Practice Address - Street 1:5701 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2207
Practice Address - Country:US
Practice Address - Phone:937-435-6222
Practice Address - Fax:937-438-8451
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009864207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3121142Medicaid
OH4301741Medicare UPIN