Provider Demographics
NPI:1912959024
Name:SHALOSKY, SARAJEAN (RT)
Entity Type:Individual
Prefix:
First Name:SARAJEAN
Middle Name:
Last Name:SHALOSKY
Suffix:
Gender:F
Credentials:RT
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 79
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-0079
Mailing Address - Country:US
Mailing Address - Phone:800-922-1270
Mailing Address - Fax:614-861-1180
Practice Address - Street 1:2198 WILLOW GLEN DR NW
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9717
Practice Address - Country:US
Practice Address - Phone:800-922-1270
Practice Address - Fax:614-861-1180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR2534598247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0789508Medicaid
OHSA3698321Medicare ID - Type Unspecified