=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033381462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. SHELLY DAVID SENDERS, MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2008
-----------------------------------------------------
Last Update Date | 07/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2054 SOUTH GREEN ROAD
-----------------------------------------------------
City | SOUTH EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-291-9210
-----------------------------------------------------
Fax | 216-291-9422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2054 SOUTH GREEN ROAD
-----------------------------------------------------
City | SOUTH EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-291-9210
-----------------------------------------------------
Fax | 216-291-9422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SHELLY D SENDERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 216-291-9210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 35053726
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------