1427059567 NPI number — SHELLY DEBBIE PESICK-CAINE M.D.

Table of content: SHELLY DEBBIE PESICK-CAINE M.D. (NPI 1427059567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427059567 NPI number — SHELLY DEBBIE PESICK-CAINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PESICK-CAINE
Provider First Name:
SHELLY
Provider Middle Name:
DEBBIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427059567
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6775 RIDGECLIFF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44139-3884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-248-2481
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6559 WILSON MILLS RD
Provider Second Line Business Practice Location Address:
BLDG D SUITE 101
Provider Business Practice Location Address City Name:
MAYFIELD VILLAGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44143-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-473-0010
Provider Business Practice Location Address Fax Number:
440-460-2812
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  35056188 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000026098 . This is a "UNICARE LIFE AND HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 380761 . This is a "WELLCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000026098 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0744921 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: R56188 . This is a "SUMMARE HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com