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General NPI Number Information
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NPI Number | 1457615213
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Entity Type | Individual
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Provider Name | SHADY NAKHLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE # DESKJ2-2
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City | CLEVELAND
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State | OH
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Zip | 44195-0005
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Country | US
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Telephone | 216-444-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-1460
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Country | US
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Telephone |
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5650
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 35.142166
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License Number State | OH
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