Healthcare Provider Details

I. General information

NPI: 1255336459
Provider Name (Legal Business Name): JOCELYN FLORENDO SHIMEK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 E 2ND ST
SALEM OH
44460
US

IV. Provider business mailing address

9471 MARKET ST STE B
NORTH LIMA OH
44452-8702
US

V. Phone/Fax

Practice location:
  • Phone: 234-567-8150
  • Fax: 234-567-8189
Mailing address:
  • Phone: 330-729-2388
  • Fax: 330-629-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34-00-3263S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: