Provider Demographics
NPI:1174639058
Name:PULLEN, SHAYLA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYLA
Middle Name:
Last Name:PULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAYLA
Other - Middle Name:
Other - Last Name:PULLEN-JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-246-7000
Mailing Address - Fax:
Practice Address - Street 1:10475 MONTGOMERY RD STE 1D
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5200
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-865-1691
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088333207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2565399Medicaid
OHI66438Medicare UPIN
OHPU4199431Medicare PIN