Provider Demographics
NPI:1336467950
Name:SHAH, MARY BETH (NP)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6499 E BROAD ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6505
Mailing Address - Country:US
Mailing Address - Phone:614-322-2500
Mailing Address - Fax:614-322-2532
Practice Address - Street 1:6499 E BROAD ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6505
Practice Address - Country:US
Practice Address - Phone:614-322-2500
Practice Address - Fax:614-322-2532
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN241927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner