Healthcare Provider Details

I. General information

NPI: 1487130308
Provider Name (Legal Business Name): SHWETA BHAVSAR MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # L3-213
CLEVELAND OH
44195-3410
US

IV. Provider business mailing address

9500 EUCLID AVE # L3-213
CLEVELAND OH
44195-3410
US

V. Phone/Fax

Practice location:
  • Phone: 216-217-1366
  • Fax:
Mailing address:
  • Phone: 216-217-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number35.142200
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number35.142200
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMT208613
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: