Provider Demographics
NPI:1033157367
Name:MEHTA, SHAILEN K (MD)
Entity Type:Individual
Prefix:
First Name:SHAILEN
Middle Name:K
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-441-8070
Mailing Address - Fax:740-446-5408
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-441-8070
Practice Address - Fax:740-446-5408
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7511208100000X
WV18701208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000185212OtherUNISON MEDICAID
WV0113594000Medicaid
250005225OtherRR MEDICARE
OH310917085142OtherCARESOURCE MEDICAID
000000007362OtherANTHEM BCBS
001714069OtherMOUNTAIN STATE BCBS
OH0995115OtherMOLINA MEDICAID
001714069OtherMOUNTAIN STATE BCBS
F94190Medicare UPIN
OH0771252Medicare PIN