Doctor Name: | MS. JEENA SHAILESH SHAH |
NPI Number: | 1083074322 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 2015006824 |
Business Practice Address: | 7951 Champaign Dr Mentor, OH - 440604076 |
Business Phone Number: | 4404770388 |
Business Fax Number: | |
Mailing Address: | 7951 Champaign Dr, MENTOR |
State: | OH |
Postal Code: | 440604076 |
Phone Number: | 4404770388 |
Fax Number: | |
NPI Enumeration Date: | 02/29/2016 |
NPI Last Update Date: | 02/29/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2015006824 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |