Provider Demographics
NPI:1952783425
Name:STEPHENS, SHAWN
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10711 ALMIRA AVE
Mailing Address - Street 2:10711 ALMIRA
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2870
Mailing Address - Country:US
Mailing Address - Phone:216-255-2734
Mailing Address - Fax:
Practice Address - Street 1:10711 ALMIRA AVE
Practice Address - Street 2:10711 ALMIRA
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2870
Practice Address - Country:US
Practice Address - Phone:216-255-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRH007358343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)