Healthcare Provider Details

I. General information

NPI: 1477850402
Provider Name (Legal Business Name): JALPA ASHOK SHAH KOTHARI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE DESK J4-1
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE DESK J4-1
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-636-1619
  • Fax:
Mailing address:
  • Phone: 440-452-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA11834-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP21764
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA11834-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: