=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851523658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR.MAHMOUD SHEHATA M.D LCC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2009
-----------------------------------------------------
Last Update Date | 08/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 W HENDERSON RD 230
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-451-8400
-----------------------------------------------------
Fax | 614-451-8402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 W HENDERSON RD 230
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-451-8400
-----------------------------------------------------
Fax | 614-451-8402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LLC MEMBER
-----------------------------------------------------
Name | DR. MAHMOUD EL-SAID SHEHATA
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 614-451-8400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 35.067742
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------