Provider Demographics
NPI:1154526242
Name:SHANK, ROBYN MICHELE
Entity type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:MICHELE
Last Name:SHANK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ROBYN
Other - Middle Name:MICHELE
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4719 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2750
Mailing Address - Country:US
Mailing Address - Phone:330-477-0326
Mailing Address - Fax:330-477-0326
Practice Address - Street 1:4719 15TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2750
Practice Address - Country:US
Practice Address - Phone:330-477-0326
Practice Address - Fax:330-477-0326
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2183453Medicaid