Provider Demographics
NPI:1750386975
Name:FAROOKI, SHELLA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:SHELLA
Middle Name:
Last Name:FAROOKI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27005 KNICKERBOCKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2388
Mailing Address - Country:US
Mailing Address - Phone:888-365-5514
Mailing Address - Fax:800-616-0084
Practice Address - Street 1:27005 KNICKERBOCKER RD STE 100
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140
Practice Address - Country:US
Practice Address - Phone:805-620-2699
Practice Address - Fax:800-616-0084
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078150174400000X
SCMD364872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196369Medicaid
OH2196369Medicaid
G96962Medicare UPIN