Healthcare Provider Details

I. General information

NPI: 1538452321
Provider Name (Legal Business Name): NICOLE MARIE SHIRILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 DODD DR
COLUMBUS OH
43210
US

IV. Provider business mailing address

700 ACKERMAN RD STE 570
COLUMBUS OH
43202-1579
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2957
  • Fax: 614-688-3700
Mailing address:
  • Phone: 614-293-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number35.131961
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: