Individual
DR. SHAUN HENNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
740 E STATE ST, SHARON, PA 16146-3328
(724) 983-7310
(724) 983-2797
Mailing address
4135 BOARDMAN CANFIELD RD, SUITE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35.054938
OH
207L00000X
Anesthesiology Physician
Primary
MD435728
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000594276
ANTHEM BCBS
OH
05
—
0014592000005
—
PA
05
—
0744298
—
OH
01
—
10828939
CAQH
—
01
—
138641ZB29
MEDICARE PTAN
PA
01
—
HE98068
HIGHMARK BCBS
PA
01
—
P00670883
MEDICARE RAILROAD
PA
Enumeration date
09/13/2005
Last updated
06/06/2019
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