Healthcare Provider Details

I. General information

NPI: 1629410121
Provider Name (Legal Business Name): ARCHANA SHENOY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 1035
CINCINNATI OH
45229
US

IV. Provider business mailing address

PO BOX 78000
DETROIT MI
48278-1676
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4261
  • Fax: 513-636-3924
Mailing address:
  • Phone: 614-722-5315
  • Fax: 614-355-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number35.138922
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2013020689
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME131663
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number35.138922
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberMT210541
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: