Healthcare Provider Details

I. General information

NPI: 1417273103
Provider Name (Legal Business Name): ANISASATTARA STERLING SHOMO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 11/16/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 BURNET AVE
CINCINNATI OH
45229-3091
US

IV. Provider business mailing address

2830 VICTORY PARKWAY PAYOR ENROLLMENT
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8600
  • Fax: 513-584-8619
Mailing address:
  • Phone: 513-585-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.120349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: