Healthcare Provider Details

I. General information

NPI: 1093777369
Provider Name (Legal Business Name): PARVIN P SHAIBANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 E MARKET ST
WARREN OH
44483-6602
US

IV. Provider business mailing address

1032 E MARKET ST
WARREN OH
44483-6602
US

V. Phone/Fax

Practice location:
  • Phone: 330-393-2585
  • Fax: 330-393-5602
Mailing address:
  • Phone: 330-393-2585
  • Fax: 330-393-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35052630
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: