Basic Information
| Provider Information | |||||||||
| NPI: | 1649404138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANLEY | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1246 ASHLAND AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437012861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404506147 | ||||||||
| FaxNumber: | 7404506157 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 MAPLE AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404545221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35.098458 | OH | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 169121 | DC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0116021552 | VA | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0113014 | 05 | OH | MEDICAID |