Provider Demographics
NPI:1073563656
Name:JALEES, SHAH A (MD)
Entity Type:Individual
Prefix:
First Name:SHAH
Middle Name:A
Last Name:JALEES
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 1:444 N MAIN ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3110
Mailing Address - Country:US
Mailing Address - Phone:330-379-9548
Mailing Address - Fax:330-379-5124
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-379-9548
Practice Address - Fax:330-379-5124
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSMD 04-304432084P0800X
OH350823772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSBJ8717540OtherDEA
KS104068Medicare ID - Type Unspecified
KSI16383Medicare UPIN