Provider Demographics
NPI:1326886540
Name:HAMBLIN, SHANNON C
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:HAMBLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 N LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-8515
Mailing Address - Country:US
Mailing Address - Phone:937-703-3274
Mailing Address - Fax:
Practice Address - Street 1:188 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-8515
Practice Address - Country:US
Practice Address - Phone:937-703-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemaker