Provider Demographics
NPI:1528808458
Name:BAUDUIN, SHANNON L
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:L
Last Name:BAUDUIN
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 1:214 HARDING AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3246
Mailing Address - Country:US
Mailing Address - Phone:330-704-4860
Mailing Address - Fax:
Practice Address - Street 1:1815 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7000
Practice Address - Country:US
Practice Address - Phone:855-441-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005124175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist