Healthcare Provider Details

I. General information

NPI: 1235556606
Provider Name (Legal Business Name): NIDHI SHAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 HOSPITAL DR SUITE 130
DUBLIN OH
43016-9600
US

IV. Provider business mailing address

6905 HOSPITAL DR SUITE 130
DUBLIN OH
43016-9600
US

V. Phone/Fax

Practice location:
  • Phone: 614-923-0300
  • Fax: 614-923-0400
Mailing address:
  • Phone: 614-923-0300
  • Fax: 614-923-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003997RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: