Healthcare Provider Details

I. General information

NPI: 1386791424
Provider Name (Legal Business Name): SHEELA BODALIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

6241 HOLLOW WOOD CIR
LOVELAND OH
45140-9112
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax:
Mailing address:
  • Phone: 513-583-0184
  • Fax: 859-392-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number038048
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: