Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.121069 | OH |
Y | 207YP0228X | Pediatric Otolaryngology | 35.121069 | OH |
NPI | 1477741783 |
---|---|
Provider Name | Dr. Jay Rajendra Shah |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 04/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0086146 | (05) | OH |