Provider Demographics
NPI:1851166151
Name:NASH, SHANNON LAVETTE
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LAVETTE
Last Name:NASH
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 1:24801 LAKE SHORE BLVD APT 711
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-4228
Mailing Address - Country:US
Mailing Address - Phone:412-304-9813
Mailing Address - Fax:
Practice Address - Street 1:24801 LAKE SHORE BLVD APT 711
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-4228
Practice Address - Country:US
Practice Address - Phone:412-304-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator