MEDICARE: KALPANA SHAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	OH
2	347C00000X	Private Vehicle	OH
3	3747P1801X	Personal Care Attendant	OH
4	376J00000X	Homemaker	OH
5	253Z00000X	In Home Supportive Care Agency	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SC392380	OTHER	OH	DRIVER LICENCE

General Provider Information

NPI Number	:	1033724471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALPANA SHAH

Provider Business Mailing Address
First Line	:	4841 WESTMINSTER LN
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2067
Country	:	US
Telephone Number	:	440-526-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	4841 WESTMINSTER LN
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2067
Country	:	US
Telephone Number	:	440-526-1088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2020
Last Update Date	:	09/12/2020

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Directions to “ KALPANA SHAH ” Practice Location

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