MEDICARE: DR. SHELLEY GITTENS 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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	35077113	OH
2	208000000X	Pediatrics Physician	35-077113	OH

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

General Provider Information

NPI Number	:	1801895990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY GITTENS MD

Provider Business Mailing Address
First Line	:	1865 TAMARACK RD
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-2305
Country	:	US
Telephone Number	:	220-564-4935
Fax Number	:	220-564-4944

Provider Business Practice Location Address
First Line	:	1865 TAMARACK RD
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055
Country	:	US
Telephone Number	:	220-564-4935
Fax Number	:	220-564-4944

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	04/13/2026

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