MEDICARE: DR. SHANELI FERNANDO M.D.

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	2085R0001X	Radiation Oncology Physician	239860	NY
2	2085R0001X	Radiation Oncology Physician	SF078490	MI
3	2085R0001X	Radiation Oncology Physician	69611-20	WI
4	2085R0001X	Radiation Oncology Physician	091524	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00630915	OTHER	OH	RR MEDICARE
4	P00630915	OTHER	MI	RR MEDICARE
5	0N24000018	OTHER	MI	MI MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508811654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANELI FERNANDO M.D.

Provider Business Mailing Address
First Line	:	3000 REGENCY CT
Second Line	:	SUITE 207
City	:	TOLEDO
State	:	OH
Zip	:	43623-3092
Country	:	US
Telephone Number	:	419-471-0493
Fax Number	:	419-474-0390

Provider Business Practice Location Address
First Line	:	3000 REGENCY CT
Second Line	:	SUITE 207
City	:	TOLEDO
State	:	OH
Zip	:	43623-3092
Country	:	US
Telephone Number	:	419-471-0493
Fax Number	:	419-474-0390

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/06/2018

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Directions to “ DR. SHANELI FERNANDO M.D.” Practice Location

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