Provider Demographics
NPI:1023137098
Name:EVANOSKI, SHAWN EDWARD
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:EDWARD
Last Name:EVANOSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E 1ST AVE
Mailing Address - Street 2:APT. #D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-8406
Mailing Address - Country:US
Mailing Address - Phone:614-291-1920
Mailing Address - Fax:
Practice Address - Street 1:35 E 1ST AVE
Practice Address - Street 2:APT. #D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-8406
Practice Address - Country:US
Practice Address - Phone:614-291-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor