Provider Demographics
NPI:1790873784
Name:SHAI, AMNON (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMNON
Middle Name:
Last Name:SHAI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24800 HIGHPOINT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6041
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:216-831-2726
Practice Address - Street 1:24800 HIGHPOINT RD
Practice Address - Street 2:SUITE B
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6041
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:216-831-2726
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP14321Medicare ID - Type Unspecified