Provider Demographics
NPI:1942012810
Name:DAVENPORT, SHAWNA MAE
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MAE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:MAE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2019 PHEASANT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-5104
Mailing Address - Country:US
Mailing Address - Phone:574-377-4457
Mailing Address - Fax:
Practice Address - Street 1:2019 PHEASANT RIDGE DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-5104
Practice Address - Country:US
Practice Address - Phone:574-377-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty