Provider Demographics
NPI:1457123390
Name:SHEARER, DESHANNON NICOL
Entity Type:Individual
Prefix:
First Name:DESHANNON
Middle Name:NICOL
Last Name:SHEARER
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 1:3601 WOODRIDGE BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7505
Mailing Address - Country:US
Mailing Address - Phone:513-591-8045
Mailing Address - Fax:
Practice Address - Street 1:3601 WOODRIDGE BLVD APT 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7505
Practice Address - Country:US
Practice Address - Phone:513-591-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN916943172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver