Provider Demographics
NPI:1649404138
Name:HANLEY, SHANNON M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:HANLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 ASHLAND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2861
Mailing Address - Country:US
Mailing Address - Phone:740-450-6147
Mailing Address - Fax:740-450-6157
Practice Address - Street 1:2800 MAPLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1716
Practice Address - Country:US
Practice Address - Phone:740-454-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098458208600000X, 208600000X
DC169121208600000X
VA0116021552208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0113014Medicaid