Provider Demographics
NPI:1578367801
Name:BERRY, SHAUN JAMAR SR
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:JAMAR
Last Name:BERRY
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7833 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HEALTHY
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3111
Mailing Address - Country:US
Mailing Address - Phone:513-544-0225
Mailing Address - Fax:
Practice Address - Street 1:7833 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HEALTHY
Practice Address - State:OH
Practice Address - Zip Code:45231-3111
Practice Address - Country:US
Practice Address - Phone:513-544-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X, 251X00000X, 253Z00000X, 261QA0600X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No376J00000XNursing Service Related ProvidersHomemaker