Provider Demographics
NPI:1134851751
Name:MARTIN, SHAWN THOMAS (MSN, APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:THOMAS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 EDENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3128
Mailing Address - Country:US
Mailing Address - Phone:330-466-9328
Mailing Address - Fax:
Practice Address - Street 1:8261 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6254
Practice Address - Country:US
Practice Address - Phone:330-286-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.406433163W00000X
OHAPRN.CNP.0031656363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse