MEDICARE: JEFFREY SHALL MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number	:	1316775802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY SHALL MD

Provider Business Mailing Address
First Line	:	7345 EDWARDS LNDG
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-1429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29001 CEDAR RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-4062
Country	:	US
Telephone Number	:	216-973-5807
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JEFFREY SHALL
Credential	:	MD
Telephone Number	:	216-952-9797

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	02/10/2025

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