Healthcare Provider Details

I. General information

NPI: 1306343397
Provider Name (Legal Business Name): SHAHED ELHAMDANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 CENTRE VIEW BLVD
CRESTVIEW HILLS KY
41017-3400
US

IV. Provider business mailing address

PO BOX 643398
CINCINNATI OH
45264-3398
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-1100
  • Fax: 859-341-3913
Mailing address:
  • Phone: 513-221-1100
  • Fax: 513-569-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA200569
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number62008
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.155714
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: