Provider Demographics
NPI:1043991714
Name:BONNER, SHAUN (OCPSA)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:BONNER
Suffix:
Gender:M
Credentials:OCPSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27801 EUCLID AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3547
Mailing Address - Country:US
Mailing Address - Phone:216-417-1007
Mailing Address - Fax:
Practice Address - Street 1:27801 EUCLID AVE STE 300
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3547
Practice Address - Country:US
Practice Address - Phone:216-417-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker