Provider Demographics
NPI:1215361860
Name:SHALASH, GHADEER JEBREEL
Entity Type:Individual
Prefix:
First Name:GHADEER
Middle Name:JEBREEL
Last Name:SHALASH
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 1:5980 HERITAGE FARMS DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7944
Mailing Address - Country:US
Mailing Address - Phone:614-735-5165
Mailing Address - Fax:
Practice Address - Street 1:5980 HERITAGE FARMS DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7944
Practice Address - Country:US
Practice Address - Phone:614-735-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH392225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse