Provider Demographics
NPI:1336585884
Name:SHINY M ABRAHAM LLC
Entity Type:Organization
Organization Name:SHINY M ABRAHAM LLC
Other - Org Name:SERENITY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHINY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-469-5575
Mailing Address - Street 1:9728 SUNRAY DR
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-4255
Mailing Address - Country:US
Mailing Address - Phone:216-469-5575
Mailing Address - Fax:
Practice Address - Street 1:9728 SUNRAY DR
Practice Address - Street 2:
Practice Address - City:OLMSTED TWP
Practice Address - State:OH
Practice Address - Zip Code:44138-4255
Practice Address - Country:US
Practice Address - Phone:216-469-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0979212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty