Healthcare Provider Details

I. General information

NPI: 1225561475
Provider Name (Legal Business Name): JOHN SHABOSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # MLC2003
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # MLC2003
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-4574
  • Fax: 513-803-4493
Mailing address:
  • Phone: 513-803-4574
  • Fax: 513-803-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35.150638
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number35.150638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: