Provider Demographics
NPI:1780325480
Name:JACKSON, SHABRINA (STNA)
Entity type:Individual
Prefix:
First Name:SHABRINA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 E MARKET ST STE 106
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2460
Mailing Address - Country:US
Mailing Address - Phone:234-226-0936
Mailing Address - Fax:
Practice Address - Street 1:1467 BEARDSLEY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-2301
Practice Address - Country:US
Practice Address - Phone:234-226-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251E00000XAgenciesHome Health