Healthcare Provider Details

I. General information

NPI: 1518938786
Provider Name (Legal Business Name): ANDREA J SHAER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 BELMONT AVE. STE. 2300
YOUNGSTOWN OH
44504-1191
US

IV. Provider business mailing address

1340 BELMONT AVE. STE. 2300
YOUNGSTOWN OH
44504-1191
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-1488
  • Fax: 330-746-5611
Mailing address:
  • Phone: 330-746-1488
  • Fax: 330-746-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35086118
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD420506
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: