Provider Demographics
NPI:1962986372
Name:SHANNON JAP MD LLC
Entity type:Organization
Organization Name:SHANNON JAP MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-226-5484
Mailing Address - Street 1:571 HIGH ST STE 11
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4132
Mailing Address - Country:US
Mailing Address - Phone:614-226-5484
Mailing Address - Fax:937-606-3077
Practice Address - Street 1:571 HIGH ST STE 11
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4132
Practice Address - Country:US
Practice Address - Phone:614-226-5484
Practice Address - Fax:937-606-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty