Provider Demographics
NPI:1467497818
Name:SOOD, SHALINI (MD)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:SOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4314
Mailing Address - Country:US
Mailing Address - Phone:216-831-0120
Mailing Address - Fax:
Practice Address - Street 1:6000 W CREEK RD
Practice Address - Street 2:SUITE 10
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2182
Practice Address - Country:US
Practice Address - Phone:180-011-3227
Practice Address - Fax:216-445-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057913207W00000X
IL036.118633207W00000X
OH35097893207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL554820OtherMEDICARE ID
IL554820OtherMEDICARE ID