Healthcare Provider Details

I. General information

NPI: 1285689976
Provider Name (Legal Business Name): SHALINI BAHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHALINI ANNAMRAJU MD

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8363 YANKEE ST
DAYTON OH
45458-1809
US

IV. Provider business mailing address

1029 STAY LIT CT
BELLBROOK OH
45305-8981
US

V. Phone/Fax

Practice location:
  • Phone: 937-885-4412
  • Fax: 937-977-1705
Mailing address:
  • Phone: 937-284-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35073578
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: