MEDICARE: SHANE E DULEMBA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	COA.15031-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144299843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE E DULEMBA NP

Provider Business Mailing Address
First Line	:	7777 YANKEE RD
Second Line	:	PSYCHIATRY - LIBERTY CAMPUS ML 16066
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-3500
Country	:	US
Telephone Number	:	513-803-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 YANKEE RD
Second Line	:	PSYCHIATRY - LIBERTY CAMPUS ML 16066
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-3500
Country	:	US
Telephone Number	:	513-803-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	09/05/2014

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Directions to “ SHANE E DULEMBA NP” Practice Location

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