MEDICARE: BIANCA M. SHAH AA

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	367H00000X	Anesthesiologist Assistant	67.000253	OH

General Provider Information

NPI Number	:	1932588399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA M. SHAH AA

Provider Business Mailing Address
First Line	:	2400 N STAR LN
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-2016
Country	:	US
Telephone Number	:	440-623-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 N STAR LN
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-2016
Country	:	US
Telephone Number	:	440-623-2340
Fax Number	:

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	10/08/2025

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