Healthcare Provider Details

I. General information

NPI: 1871060608
Provider Name (Legal Business Name): AHMED F SHAHATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 GLESSNER AVE FL 2
MANSFIELD OH
44903-2269
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 567-241-7055
  • Fax: 567-241-7565
Mailing address:
  • Phone: 570-808-7916
  • Fax: 570-808-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD472659
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.135087
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.135087
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: