Provider Demographics
NPI:1003510371
Name:DALAL, SHRUSHTI YASHESH
Entity Type:Individual
Prefix:
First Name:SHRUSHTI
Middle Name:YASHESH
Last Name:DALAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483
Mailing Address - Country:US
Mailing Address - Phone:330-675-5714
Mailing Address - Fax:330-675-5721
Practice Address - Street 1:1350 E MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-841-9470
Practice Address - Fax:330-884-0656
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program