Provider Demographics
NPI:1033381462
Name:DR. SHELLY DAVID SENDERS, MD, INC
Entity Type:Organization
Organization Name:DR. SHELLY DAVID SENDERS, MD, INC
Other - Org Name:SENDERS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SENDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-291-9210
Mailing Address - Street 1:2054 SOUTH GREEN ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-291-9210
Mailing Address - Fax:216-291-9422
Practice Address - Street 1:2054 SOUTH GREEN ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-291-9210
Practice Address - Fax:216-291-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141751Medicaid