Provider Demographics
NPI:1457760167
Name:SHAKARASHVILI, NODAR (PT)
Entity Type:Individual
Prefix:
First Name:NODAR
Middle Name:
Last Name:SHAKARASHVILI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3867
Mailing Address - Country:US
Mailing Address - Phone:440-533-5889
Mailing Address - Fax:
Practice Address - Street 1:33790 BAINBRIDGE RD STE 205
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2982
Practice Address - Country:US
Practice Address - Phone:440-248-9255
Practice Address - Fax:440-248-3608
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT. 014864208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation