Provider Demographics
NPI:1689771933
Name:VERMA, SHANNON MICHELLE NOVOSAD (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE NOVOSAD
Last Name:VERMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MICHELLE
Other - Last Name:NOVOSAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10708 COUNTRY WALK CT.
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5300 FAR HILLS AVENUE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2347
Practice Address - Country:US
Practice Address - Phone:937-433-7536
Practice Address - Fax:937-433-9612
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090812207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2130350OtherCIGNA
OH9624134OtherAETNA
OH000000571667OtherANTHEM BC/BS
OHP00640612OtherRAILROAD MEDICARE
OH2927826OtherUNITED HEALTHCARE
OH1900423OtherCOVENTRY HEALTH
OHP00640612OtherRAILROAD MEDICARE