Provider Demographics
NPI:1851529234
Name:MOHAN, SHAULNIE (MD)
Entity Type:Individual
Prefix:
First Name:SHAULNIE
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-795-5970
Mailing Address - Fax:207-795-7193
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:STE. 102
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-5970
Practice Address - Fax:207-795-7193
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20239207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology