Healthcare Provider Details

I. General information

NPI: 1003281064
Provider Name (Legal Business Name): RASHID SHAIBU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 17TH AVE
COLUMBUS OH
43219-1002
US

IV. Provider business mailing address

2780 AIRPORT DR STE 100
COLUMBUS OH
43219-2289
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-2700
  • Fax: 614-645-5517
Mailing address:
  • Phone: 614-859-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.417935
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: