Provider Demographics
NPI:1770607707
Name:PAIGE, SHANNON M
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:PAIGE
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 1:2689 WALDEN BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1748
Mailing Address - Country:US
Mailing Address - Phone:614-377-5157
Mailing Address - Fax:
Practice Address - Street 1:2689 WALDEN BLUFF CT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1748
Practice Address - Country:US
Practice Address - Phone:614-377-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2402895Medicaid