MEDICARE: DR. SHADY NAKHLA M.D.

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	207R00000X	Internal Medicine Physician	5650	MD
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	35.142166	OH

General Provider Information

NPI Number	:	1457615213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHADY NAKHLA M.D.

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # DESKJ2-2
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0005
Country	:	US
Telephone Number	:	216-444-2131
Fax Number	:

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	01/15/2024

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