Provider Demographics
NPI:1952747743
Name:IAROCCI, SHAUNA L
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:L
Last Name:IAROCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:LYNN
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2594
Mailing Address - Fax:
Practice Address - Street 1:300 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-293-5000
Practice Address - Fax:614-293-6420
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15053-NP363LA2200X
OH374715163W00000X
NY593443163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse