Healthcare Provider Details

I. General information

NPI: 1275964934
Provider Name (Legal Business Name): MANA MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 GREENLAWN AVE
COLUMBUS OH
43223-2616
US

IV. Provider business mailing address

8163 CAMPDEN LAKES BLVD
DUBLIN OH
43016-8254
US

V. Phone/Fax

Practice location:
  • Phone: 614-449-9664
  • Fax: 614-444-7919
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.097615
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number35.097615
License Number StateOH

VIII. Authorized Official

Name: BINIT J SHAH
Title or Position: OWNER
Credential: M.D.
Phone: 202-491-3733