Provider Demographics
NPI:1932362845
Name:SHIMALA, TARA MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:MARIE
Last Name:SHIMALA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1008
Mailing Address - Country:US
Mailing Address - Phone:513-221-0527
Mailing Address - Fax:513-221-1703
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2426
Practice Address - Country:US
Practice Address - Phone:513-221-0527
Practice Address - Fax:513-221-1703
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01646231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4241241Medicare PIN