Provider Demographics
NPI:1811564883
Name:SPIRES, SHAWNTEONA
Entity Type:Individual
Prefix:
First Name:SHAWNTEONA
Middle Name:
Last Name:SPIRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 S WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3055
Mailing Address - Country:US
Mailing Address - Phone:716-327-2305
Mailing Address - Fax:
Practice Address - Street 1:234 S WARREN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3055
Practice Address - Country:US
Practice Address - Phone:716-327-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty