Provider Demographics
NPI:1740389576
Name:NANAVATI, SHAILESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAILESH
Middle Name:
Last Name:NANAVATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAILESH
Other - Middle Name:
Other - Last Name:NANAVATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15644 MADISON AVE.
Mailing Address - Street 2:SUIT # 206
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:216-221-3522
Mailing Address - Fax:216-221-0286
Practice Address - Street 1:15644 MADISON AVE.
Practice Address - Street 2:SUIT # 206
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:216-221-3522
Practice Address - Fax:216-221-0286
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.043201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics