Provider Demographics
NPI:1942256755
Name:AMIN, SHAMA A (MD)
Entity Type:Individual
Prefix:
First Name:SHAMA
Middle Name:A
Last Name:AMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-981-5123
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3971
Practice Address - Country:US
Practice Address - Phone:419-226-9694
Practice Address - Fax:419-226-9279
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042953A2080P0204X
OH350429532080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000317845OtherBCBS
OH000000317845OtherBCBS
OH0384098Medicaid
OHAM455785Medicare PIN
OH000000317845OtherBCBS
AM0455784Medicare PIN
000000317845OtherBCBS