1609956747 NPI number — MRS. SHIRLEY PATTERSON DASH RD/LD

Table of content: MRS. SHIRLEY PATTERSON DASH RD/LD (NPI 1609956747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609956747 NPI number — MRS. SHIRLEY PATTERSON DASH RD/LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DASH
Provider First Name:
SHIRLEY
Provider Middle Name:
PATTERSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD/LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILKES
Provider Other First Name:
SHIRLEY
Provider Other Middle Name:
PATTERSON
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD LD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609956747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19298 TRILLIUM TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRONGSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44149-3146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-572-1190
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7007 POWERS BLVD
Provider Second Line Business Practice Location Address:
PARMA COMMUNITY GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44129-4495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-743-2150
Provider Business Practice Location Address Fax Number:
440-743-2280
Provider Enumeration Date:
10/16/2006

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: 133V00000X , with the licence number:  177 , 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)





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