Provider Demographics
NPI:1235556606
Name:SHAH, NIDHI (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:NIDHI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 HOSPITAL DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9600
Mailing Address - Country:US
Mailing Address - Phone:614-923-0300
Mailing Address - Fax:614-923-0400
Practice Address - Street 1:6905 HOSPITAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9600
Practice Address - Country:US
Practice Address - Phone:614-923-0300
Practice Address - Fax:614-923-0400
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003997RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109442Medicaid