Provider Demographics
NPI:1962242974
Name:AUSTIN, SHAWN PAUL SR
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:PAUL
Last Name:AUSTIN
Suffix:SR
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 1:8402 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1646
Mailing Address - Country:US
Mailing Address - Phone:216-387-0187
Mailing Address - Fax:
Practice Address - Street 1:8402 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1646
Practice Address - Country:US
Practice Address - Phone:216-387-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator