Provider Demographics
NPI:1396968764
Name:MARCUS, SHAWN L (CPED)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:MARCUS
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9145
Mailing Address - Country:US
Mailing Address - Phone:859-489-4780
Mailing Address - Fax:859-623-5014
Practice Address - Street 1:2573 RICHMOND RD
Practice Address - Street 2:SUITE 385
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1700
Practice Address - Country:US
Practice Address - Phone:859-489-4780
Practice Address - Fax:859-266-7888
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist