Provider Demographics
NPI:1891556460
Name:MODI, SHREYA (MSN APRN-CNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHREYA
Middle Name:
Last Name:MODI
Suffix:
Gender:F
Credentials:MSN APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1014 BRAMPTON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9718
Mailing Address - Country:US
Mailing Address - Phone:517-282-4417
Mailing Address - Fax:
Practice Address - Street 1:1014 BRAMPTON PARK RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-9718
Practice Address - Country:US
Practice Address - Phone:517-282-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035647363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner