Provider Demographics
NPI:1124778147
Name:JONAS, SHIANNE VIOLET
Entity type:Individual
Prefix:
First Name:SHIANNE
Middle Name:VIOLET
Last Name:JONAS
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 1:1438 DANIELS RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9545
Mailing Address - Country:US
Mailing Address - Phone:405-400-6039
Mailing Address - Fax:
Practice Address - Street 1:1438 DANIELS RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9545
Practice Address - Country:US
Practice Address - Phone:405-400-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH910002086014Medicaid