Healthcare Provider Details

I. General information

NPI: 1053654004
Provider Name (Legal Business Name): ELIZABETH SHANIKA ESPARAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH SHANIKA RANASINGHE

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 08/11/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 STATE ROUTE 59
KENT OH
44240-4113
US

IV. Provider business mailing address

2005 BAY ST STE 206
TAUNTON MA
02780-1085
US

V. Phone/Fax

Practice location:
  • Phone: 330-678-0201
  • Fax: 330-678-4272
Mailing address:
  • Phone: 508-823-7473
  • Fax: 508-824-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number35133065
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35133065
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: