Provider Demographics
NPI:1578285797
Name:INNOCENT, AMBE SHU (MD)
Entity Type:Individual
Prefix:
First Name:AMBE
Middle Name:SHU
Last Name:INNOCENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 KENILWORTH CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4235
Mailing Address - Country:US
Mailing Address - Phone:513-383-7676
Mailing Address - Fax:
Practice Address - Street 1:3615 KENILWORTH CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4235
Practice Address - Country:US
Practice Address - Phone:513-383-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide