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General NPI Number Information
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NPI Number | 1508811654
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Entity Type | Individual
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Provider Name | SHANELI FERNANDO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 3000 REGENCY CT SUITE 207
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City | TOLEDO
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State | OH
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Zip | 43623-3092
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Country | US
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Telephone | 419-471-0493
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Fax | 419-474-0390
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Provider Business Mailing Address
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Address Line | 3000 REGENCY CT SUITE 207
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City | TOLEDO
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State | OH
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Zip | 43623-3092
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Country | US
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Telephone | 419-471-0493
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Fax | 419-474-0390
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 239860
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | SF078490
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 69611-20
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 091524
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License Number State | OH
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