Provider Demographics
NPI:1265248421
Name:MIENKO, SHAUN JOSEPH
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:JOSEPH
Last Name:MIENKO
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 1:8260 CAMDEN SUGAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311-8535
Mailing Address - Country:US
Mailing Address - Phone:513-292-2953
Mailing Address - Fax:
Practice Address - Street 1:8260 CAMDEN SUGAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45311-8535
Practice Address - Country:US
Practice Address - Phone:513-292-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker