Provider Demographics
NPI:1265193809
Name:GRAYBILL, SHAWNA M
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 S MAIN ST # 107
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-4401
Mailing Address - Country:US
Mailing Address - Phone:330-368-2400
Mailing Address - Fax:
Practice Address - Street 1:526 S MAIN ST # 107
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-4401
Practice Address - Country:US
Practice Address - Phone:330-368-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103568-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor