Provider Demographics
NPI:1063978294
Name:MASON, SHAWN PATRICK (SA-C)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PATRICK
Last Name:MASON
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 WASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:BERKEY
Mailing Address - State:OH
Mailing Address - Zip Code:43504-9700
Mailing Address - Country:US
Mailing Address - Phone:419-466-0261
Mailing Address - Fax:
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-466-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty