Healthcare Provider Details

I. General information

NPI: 1316350663
Provider Name (Legal Business Name): PRATIMA RAMESH SHANBHAG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MAYERSON CENTER
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVENUE MLC 3008
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7233
  • Fax: 407-872-0544
Mailing address:
  • Phone: 513-803-1178
  • Fax: 513-636-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN20214
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.131142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: