Healthcare Provider Details

I. General information

NPI: 1013953603
Provider Name (Legal Business Name): SHELDON POLONSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BEEKMAN STREET
CINCINNATI OH
45255
US

IV. Provider business mailing address

2750 BEEKMAN STREET
CINCINNATI OH
45255
US

V. Phone/Fax

Practice location:
  • Phone: 513-517-2000
  • Fax: 513-517-2022
Mailing address:
  • Phone: 513-517-2000
  • Fax: 513-517-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35060111
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: