Healthcare Provider Details

I. General information

NPI: 1093644601
Provider Name (Legal Business Name): RAM SHAHDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24541 ANNIE LN
WESTLAKE OH
44145-4144
US

IV. Provider business mailing address

24541 ANNIE LN
WESTLAKE OH
44145-4144
US

V. Phone/Fax

Practice location:
  • Phone: 813-703-7836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: