Provider Demographics
NPI:1730193863
Name:MORRISON, SHAUN (PA)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:MORRISON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 BURNINGTREE DR
Mailing Address - Street 2:#7
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:BLDG A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:419-578-7200
Practice Address - Fax:419-537-5600
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0111198Medicaid
OHMOPA27641Medicare PIN
OH0111198Medicaid