Healthcare Provider Details

I. General information

NPI: 1689584849
Provider Name (Legal Business Name): MR. EYAS SHANAAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EYAS YOUNIS

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7433 BALLYCASTLE DR
COLUMBUS OH
43235-8933
US

IV. Provider business mailing address

7433 BALLYCASTLE DR
COLUMBUS OH
43235-8933
US

V. Phone/Fax

Practice location:
  • Phone: 917-832-5287
  • Fax:
Mailing address:
  • Phone: 917-832-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: