Healthcare Provider Details

I. General information

NPI: 1386934982
Provider Name (Legal Business Name): HEIDI J COHER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI J SHLENSKY PA-C

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 E US HIGHWAY 36 # 100
AVON IN
46123-7960
US

IV. Provider business mailing address

8607 E US HIGHWAY 36 # 100
AVON IN
46123-7960
US

V. Phone/Fax

Practice location:
  • Phone: 317-208-3866
  • Fax: 317-208-3867
Mailing address:
  • Phone: 317-208-3866
  • Fax: 317-208-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001266A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: