Provider Demographics
NPI:1932588399
Name:SHAH, BIANCA M (AA-C)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N STAR LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2016
Mailing Address - Country:US
Mailing Address - Phone:440-623-2340
Mailing Address - Fax:
Practice Address - Street 1:2400 N STAR LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2016
Practice Address - Country:US
Practice Address - Phone:440-623-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000253367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant