Healthcare Provider Details

I. General information

NPI: 1720157738
Provider Name (Legal Business Name): SHACHI SINGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9946 HUNTERSRUN LN
CINCINNATI OH
45242-5448
US

IV. Provider business mailing address

9946 HUNTERSRUN LN
CINCINNATI OH
45242-5448
US

V. Phone/Fax

Practice location:
  • Phone: 513-293-4222
  • Fax: 513-793-1422
Mailing address:
  • Phone: 513-293-4222
  • Fax: 513-793-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-084336
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38380
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35-084336
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number38380
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: