Active NPI
Shannon Marie Mollenkopf, NP
- Pediatrics Physician
- Canfield, OH
National Provider Identifier
1710453832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- APRN.CNP.023776
- Practice address
- 4133 Boardman Canfield Rd
Canfield, OH 44406-9047 - Phone
- (330) 702-5437
- Fax
- (330) 702-8684
- NPI assigned
- Oct 16, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | APRN.CNP.023776 | OH | Primary |
Addresses
Primary practice location
4133 Boardman Canfield Rd
Canfield, OH 44406-9047
Mailing address
4133 Boardman Canfield Rd
Canfield, OH 44406-9047
Phone (330) 702-5437
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN.CNP.023776 | OH | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539648000000",
"number": "1710453832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4133 BOARDMAN CANFIELD RD",
"city": "CANFIELD",
"state": "OH",
"postal_code": "444069047",
"telephone_number": "330-702-5437",
"fax_number": "330-702-8684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4133 BOARDMAN CANFIELD RD",
"city": "CANFIELD",
"state": "OH",
"postal_code": "444069047",
"telephone_number": "330-702-5437",
"fax_number": "330-702-8684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOLLENKOPF",
"first_name": "SHANNON",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-16",
"last_updated": "2018-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "APRN.CNP.023776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.