Provider Demographics
NPI:1265202162
Name:DAVIDSON, SHAUN JAMAUR
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:JAMAUR
Last Name:DAVIDSON
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 1:4525 LAKESIDE ST S APT D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4335
Mailing Address - Country:US
Mailing Address - Phone:614-460-1120
Mailing Address - Fax:
Practice Address - Street 1:4525 LAKESIDE ST S APT D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4335
Practice Address - Country:US
Practice Address - Phone:614-460-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional