Provider Demographics
NPI:1609895952
Name:RAHMAN, SHAKIL S (MD)
Entity Type:Individual
Prefix:
First Name:SHAKIL
Middle Name:S
Last Name:RAHMAN
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 1:8614 SHEPHERD FARM DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1128
Mailing Address - Country:US
Mailing Address - Phone:513-942-9500
Mailing Address - Fax:513-942-9501
Practice Address - Street 1:8614 SHEPHERD FARM DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1128
Practice Address - Country:US
Practice Address - Phone:513-942-9500
Practice Address - Fax:513-942-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350860692084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000363277OtherANTHEM
OH2571873Medicaid
OHRA7334401Medicare ID - Type Unspecified
OH132756Medicare UPIN