1306928817 NPI number — DR. SHABANA J DEWANI MD

Table of content: DR. SHABANA J DEWANI MD (NPI 1306928817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306928817 NPI number — DR. SHABANA J DEWANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWANI
Provider First Name:
SHABANA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1306928817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 JASONWAY AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43214-4359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-442-3130
Provider Business Mailing Address Fax Number:
614-442-3145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 JASONWAY AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43214-4359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-442-3130
Provider Business Practice Location Address Fax Number:
614-442-3145
Provider Enumeration Date:
10/20/2006

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: 207R00000X , with the licence number:  OHIO TRAINING CERTIF , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 35093809 , 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: 0087900 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".