Provider Demographics
NPI:1205688991
Name:BUCHANAN, SHETORIA (LPN)
Entity type:Individual
Prefix:
First Name:SHETORIA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4069 BRADLEY CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2565
Mailing Address - Country:US
Mailing Address - Phone:866-835-1364
Mailing Address - Fax:
Practice Address - Street 1:4069 BRADLEY CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2565
Practice Address - Country:US
Practice Address - Phone:866-835-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.138697.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse