Provider Demographics
NPI:1841311792
Name:BENSON, SHAWN
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:BENSON
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 1:43189 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:BEALLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43716-9569
Mailing Address - Country:US
Mailing Address - Phone:740-310-9587
Mailing Address - Fax:
Practice Address - Street 1:43189 OHIO AVE
Practice Address - Street 2:
Practice Address - City:BEALLSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43716-9569
Practice Address - Country:US
Practice Address - Phone:740-310-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2435823251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health