Provider Demographics
NPI:1528019288
Name:SHALASH, AMINA (MD)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:SHALASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4 N HIGHLAND ST
Mailing Address - Street 2:STE A
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2024
Mailing Address - Country:US
Mailing Address - Phone:859-744-1445
Mailing Address - Fax:859-744-1442
Practice Address - Street 1:1110 MCCANN DR
Practice Address - Street 2:SUITE B
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1157
Practice Address - Country:US
Practice Address - Phone:859-744-1445
Practice Address - Fax:859-744-1442
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64052665Medicaid
KYH52234Medicare UPIN
KY64052665Medicaid