Healthcare Provider Details

I. General information

NPI: 1295224814
Provider Name (Legal Business Name): SHRUTI AMIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 CENTRAL AVE
MIDDLETOWN OH
45044-5353
US

IV. Provider business mailing address

PO BOX 330
LOVELAND OH
45140-0330
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-7246
  • Fax:
Mailing address:
  • Phone: 513-454-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35.145288
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: