Active NPI
Shawn A Wagner
- Homemaker
- Massillon, OH
National Provider Identifier
1124621560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homemaker
- License
- 7609896
- Practice address
- 8115 Windy LN NW
Massillon, OH 44646-1188 - Phone
- (330) 806-4112
- NPI assigned
- Nov 18, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | 7609896 | OH | Primary |
Addresses
Primary practice location
8115 Windy LN NW
Massillon, OH 44646-1188
Mailing address
8115 Windy LN NW
Massillon, OH 44646-1188
Phone (330) 806-4112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7609896 | OH | MD | Homemaker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1124621560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8115 WINDY LN NW",
"city": "MASSILLON",
"state": "OH",
"postal_code": "446461188",
"telephone_number": "330-806-4112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8115 WINDY LN NW",
"city": "MASSILLON",
"state": "OH",
"postal_code": "446461188",
"telephone_number": "330-806-4112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "SHAWN",
"middle_name": "A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": "OH",
"license": "7609896",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Massillon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.