Provider Demographics
NPI:1508063090
Name:SHETH, NIYATI PANKAJ (DO)
Entity Type:Individual
Prefix:
First Name:NIYATI
Middle Name:PANKAJ
Last Name:SHETH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 KOLBE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-233-0138
Mailing Address - Fax:440-242-0571
Practice Address - Street 1:3600 KOLBE RD STE 206
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-233-0138
Practice Address - Fax:440-242-0571
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009579207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2978836Medicaid
OH3025372Medicaid
OH2978836Medicaid
OH3025372Medicaid
OH9389631Medicare PIN