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General NPI Number Information
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NPI Number | 1538312228
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Entity Type | Individual
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Provider Name | PIAM SHANEHSAZ
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 3535 SOUTHERN BLVD
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City | KETTERING
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State | OH
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Zip | 45429-1221
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Country | US
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Telephone | 937-395-6665
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Fax | 937-395-6668
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Provider Business Mailing Address
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Address Line | 1 PRESTIGE PL STE 550
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City | MIAMISBURG
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State | OH
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Zip | 45342-6115
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Country | US
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Telephone | 937-766-2131
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Fax | 937-522-8068
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35.096488
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 44158
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.096488
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 44158
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License Number State | KY
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