Provider Demographics
NPI:1699160176
Name:DEWEY, SHAUNA (LISW-S)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:DEWEY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-2000
Mailing Address - Country:US
Mailing Address - Phone:440-969-5983
Mailing Address - Fax:
Practice Address - Street 1:215 MILLER RD STE 7
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1013
Practice Address - Country:US
Practice Address - Phone:216-932-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1450437104100000X
OHI.1801001-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker