Provider Demographics
NPI:1790456069
Name:SPEARS, SHANNAH NICOLE (STNA)
Entity Type:Individual
Prefix:
First Name:SHANNAH
Middle Name:NICOLE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 TOMAHAWK ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-1031
Mailing Address - Country:US
Mailing Address - Phone:330-524-5004
Mailing Address - Fax:
Practice Address - Street 1:1280 TOMAHAWK ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-1031
Practice Address - Country:US
Practice Address - Phone:330-524-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 251K00000X
OH410993670817376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No172A00000XOther Service ProvidersDriver
No251K00000XAgenciesPublic Health or Welfare