Provider Demographics
NPI:1104455310
Name:SHEVELSON, KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SHEVELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SENTELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1021 COUNTRY CLUB RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2484
Mailing Address - Country:US
Mailing Address - Phone:614-501-7337
Mailing Address - Fax:614-434-2701
Practice Address - Street 1:905 OLD DILEY RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-2113
Practice Address - Country:US
Practice Address - Phone:614-864-3222
Practice Address - Fax:614-863-7388
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.250015208000000X
390200000X
OH35.148242208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program