Provider Demographics
NPI:1518009844
Name:SHANKER, JAYMIE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYMIE
Middle Name:ANNE
Last Name:SHANKER
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 1:19202 LOMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5108
Mailing Address - Country:US
Mailing Address - Phone:216-295-8488
Mailing Address - Fax:
Practice Address - Street 1:24075 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5846
Practice Address - Country:US
Practice Address - Phone:216-292-3999
Practice Address - Fax:216-292-6313
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0686822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2342058Medicaid
OH0959566Medicaid
OH0959566Medicaid
OH4065223Medicare ID - Type Unspecified
OH2342058Medicaid