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General NPI Number Information
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NPI Number | 1083609622
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Entity Type | Individual
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Provider Name | SHOBHA KHANDELWAL M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 970 E WASHINGTON ST STE-2F
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City | MEDINA
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State | OH
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Zip | 44256-3332
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Country | US
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Telephone | 330-723-7999
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Fax | 330-764-9907
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Provider Business Mailing Address
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Address Line | 970 E WASHINGTON ST STE 2F
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City | MEDINA
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State | OH
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Zip | 44256-2181
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Country | US
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Telephone | 330-722-8886
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Fax | 330-764-9907
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 054767K
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License Number State | OH
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